Healthcare Provider Details

I. General information

NPI: 1245115963
Provider Name (Legal Business Name): WESLEY COMMUNITY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5845 E STILL CIR
MESA AZ
85206-3607
US

IV. Provider business mailing address

1300 S 10TH ST
PHOENIX AZ
85034-4516
US

V. Phone/Fax

Practice location:
  • Phone: 602-257-4323
  • Fax: 602-257-4338
Mailing address:
  • Phone: 602-257-4323
  • Fax: 602-257-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BLAINE BANDI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 602-368-9616