Healthcare Provider Details

I. General information

NPI: 1144331679
Provider Name (Legal Business Name): WESLEY RETIREMENT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 1ST ST N
NEWTON IA
50208-3119
US

IV. Provider business mailing address

500 1ST ST N
NEWTON IA
50208-3119
US

V. Phone/Fax

Practice location:
  • Phone: 641-791-5000
  • Fax: 641-791-4522
Mailing address:
  • Phone: 641-791-5000
  • Fax: 641-791-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN773
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier0808840
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MR. CAL SHELANGOSKI
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 515-271-6896