Provider Demographics
NPI:1881900579
Name:WESLEY & EDWIN, LLC
Entity type:Organization
Organization Name:WESLEY & EDWIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASHLEY-HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-550-2642
Mailing Address - Street 1:7905 MARQUETTE AVE NE
Mailing Address - Street 2:UNIT B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-6703
Mailing Address - Country:US
Mailing Address - Phone:505-550-2642
Mailing Address - Fax:267-276-0511
Practice Address - Street 1:221 CONCHAS ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2703
Practice Address - Country:US
Practice Address - Phone:505-550-2642
Practice Address - Fax:267-276-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251G00000XAgenciesHospice Care, Community Based
No251K00000XAgenciesPublic Health or Welfare
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization