Provider Demographics
NPI:1649840638
Name:WESLEY HOMES HOSPICE, LLC
Entity type:Organization
Organization Name:WESLEY HOMES HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-870-1118
Mailing Address - Street 1:18000 72ND AVE S STE 217
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-1035
Mailing Address - Country:US
Mailing Address - Phone:206-870-1118
Mailing Address - Fax:206-870-4165
Practice Address - Street 1:18000 72ND AVE S STE 217
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1035
Practice Address - Country:US
Practice Address - Phone:206-870-1118
Practice Address - Fax:206-870-4165
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESLEY HOMES HOSPICE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2098216Medicaid