Provider Demographics
NPI:1669716080
Name:WESLEY PARTNERS SENIOR LIVING LLC
Entity type:Organization
Organization Name:WESLEY PARTNERS SENIOR LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:G
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-537-4116
Mailing Address - Street 1:PO BOX 612
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-0612
Mailing Address - Country:US
Mailing Address - Phone:903-537-4116
Mailing Address - Fax:903-270-6227
Practice Address - Street 1:13923 FM 2710
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-6632
Practice Address - Country:US
Practice Address - Phone:903-882-9296
Practice Address - Fax:903-881-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAPPLIED FOR310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility