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General NPI Number Information
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NPI Number | 1477404630
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Entity Type | Organization
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Legal Business Name | WEZESHA GROUP LLC
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Dates
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Enumeration Date | 02/04/2026
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 2107 PLEASANT VALLEY DR
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City | CONWAY
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State | AR
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Zip | 72032-2544
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Country | US
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Telephone | 870-995-5275
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Fax | 501-377-9013
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Provider Business Mailing Address
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Address Line | 2107 PLEASANT VALLEY DR
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City | CONWAY
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State | AR
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Zip | 72032-2544
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Country | US
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Telephone | 870-995-5275
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Fax | 501-377-9013
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANNIAS TATE
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Credential |
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Telephone | 870-995-5275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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