Provider Demographics
NPI:1295950475
Name:WESLEY HEALTHCARE INC.
Entity type:Organization
Organization Name:WESLEY HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PENSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-925-5494
Mailing Address - Street 1:1751 WESLEY RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-3647
Mailing Address - Country:US
Mailing Address - Phone:260-925-5494
Mailing Address - Fax:260-925-6183
Practice Address - Street 1:1751 WESLEY RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-3647
Practice Address - Country:US
Practice Address - Phone:260-925-5494
Practice Address - Fax:260-927-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07-000307-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100285660DMedicaid
IN100285660DMedicaid