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General NPI Number Information
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NPI Number | 1508032889
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Entity Type | Organization
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Legal Business Name | WESLEY MANOR NURSING HOME
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 5012 E MANSLICK RD
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City | LOUISVILLE
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State | KY
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Zip | 40219-5165
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Country | US
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Telephone | 502-969-3277
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Fax | 502-969-3259
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Provider Business Mailing Address
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Address Line | 5012 E MANSLICK RD
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City | LOUISVILLE
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State | KY
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Zip | 40219-5165
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Country | US
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Telephone | 502-969-3277
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Fax | 502-969-3259
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Authorized Official
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Title or Position | V.P. ADMIN. / CFO
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Name | MR. MARK STEPHENS
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Credential |
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Telephone | 502-969-3277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 100230
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License Number State | KY
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