Basic Information
| Provider Information | |||||||||
| NPI: | 1184601403 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WESLEY RETIREMENT SERVICES, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | THE VILLAGE, A WESLEYLIFE COMMUNITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1203 N E ST | ||||||||
| Address2: | |||||||||
| City: | INDIANOLA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501253276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159617458 | ||||||||
| FaxNumber: | 5159610898 | ||||||||
| Practice Location | |||||||||
| Address1: | 1203 N E ST | ||||||||
| Address2: | |||||||||
| City: | INDIANOLA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501253276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159617458 | ||||||||
| FaxNumber: | 5159610898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 09/11/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SHELANGOSKI | ||||||||
| AuthorizedOfficialFirstName: | CAL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | FINANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5152716896 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 910708 | IA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0808790 | 05 | IA | MEDICAID |