Provider Demographics
NPI:1548538283
Name:WESLEYAN HOMES, INC.
Entity type:Organization
Organization Name:WESLEYAN HOMES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-868-1205
Mailing Address - Street 1:109 ESTRELLA CROSSING
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-6973
Mailing Address - Country:US
Mailing Address - Phone:512-943-9804
Mailing Address - Fax:512-869-2687
Practice Address - Street 1:109 ESTRELLA CROSSING
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-6973
Practice Address - Country:US
Practice Address - Phone:512-863-2528
Practice Address - Fax:512-869-2687
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESLEYAN HOMES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-08
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104746310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104746OtherTEXAS FACILITY ID/VENDOR NO.