1669716080 NPI number — WESLEY PARTNERS SENIOR LIVING LLC

Table of content: (NPI 1669716080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669716080 NPI number — WESLEY PARTNERS SENIOR LIVING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESLEY PARTNERS SENIOR LIVING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669716080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 612
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75457-0612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-537-4116
Provider Business Mailing Address Fax Number:
903-270-6227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13923 FM 2710
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINDALE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75771-6632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-882-9296
Provider Business Practice Location Address Fax Number:
903-881-5742
Provider Enumeration Date:
11/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JORDAN
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
903-537-4116

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  APPLIED FOR , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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