Provider Demographics
NPI:1801080643
Name:WESLEY AT HOME, LLC
Entity type:Organization
Organization Name:WESLEY AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELANGOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-271-6896
Mailing Address - Street 1:5508 NW 88TH STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-3005
Mailing Address - Country:US
Mailing Address - Phone:515-271-6789
Mailing Address - Fax:515-271-6898
Practice Address - Street 1:944 18TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1152
Practice Address - Country:US
Practice Address - Phone:515-288-3334
Practice Address - Fax:515-288-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
IA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0672956Medicaid
IA67295OtherWELLMARK BC/BS
IA0672956Medicaid