1144886318 NPI number — WESLEY PARTNERS SENIOR LIVING LLC

Table of content: (NPI 1144886318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144886318 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:
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:
1144886318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 DALLAS ST W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT VERNON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75457-2336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-537-4522
Provider Business Mailing Address Fax Number:
903-270-6227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3291 E BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-301-4436
Provider Business Practice Location Address Fax Number:
940-301-5039
Provider Enumeration Date:
05/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
KEYS
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTANT
Authorized Official Telephone Number:
903-537-4522

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 307245 . This is a "ASSISTED LIVING FACILITY TYPE B LICENSE FROM TEXAS HEALTH AND HUMAN SERVICES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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