Provider Demographics
NPI:1952775132
Name:WESLEYAN HOMES, INC.
Entity type:Organization
Organization Name:WESLEYAN HOMES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LISTER
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:512-869-5800
Mailing Address - Street 1:4219 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1301
Mailing Address - Country:US
Mailing Address - Phone:512-869-5800
Mailing Address - Fax:512-869-2494
Practice Address - Street 1:4219 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1301
Practice Address - Country:US
Practice Address - Phone:512-869-5800
Practice Address - Fax:512-869-2494
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESLEYAN HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-25
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health