Provider Demographics
NPI:1891844767
Name:WESLEYAN HOMES, INC.
Entity Type:Organization
Organization Name:WESLEYAN HOMES, INC.
Other - Org Name:WESLEYAN HOSPICE - GEORGETOWN, TX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LISTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:512-638-8488
Mailing Address - Street 1:4219 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1301
Mailing Address - Country:US
Mailing Address - Phone:512-863-8848
Mailing Address - Fax:512-863-3117
Practice Address - Street 1:4219 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1301
Practice Address - Country:US
Practice Address - Phone:512-863-8848
Practice Address - Fax:512-863-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010524251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010524OtherTX HOSPICE LICENSE
TX67-1546Medicare ID - Type UnspecifiedMEDICARE HOSPICE PROVIDER