Provider Demographics
NPI:1144886318
Name:WESLEY PARTNERS SENIOR LIVING LLC
Entity type:Organization
Organization Name:WESLEY PARTNERS SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-537-4522
Mailing Address - Street 1:110 DALLAS ST W
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-2336
Mailing Address - Country:US
Mailing Address - Phone:903-537-4522
Mailing Address - Fax:903-270-6227
Practice Address - Street 1:3291 E BROADWAY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240
Practice Address - Country:US
Practice Address - Phone:940-301-4436
Practice Address - Fax:940-301-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307245OtherASSISTED LIVING FACILITY TYPE B LICENSE FROM TEXAS HEALTH AND HUMAN SERVICES