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General NPI Number Information
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NPI Number | 1972775203
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Entity Type | Organization
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Legal Business Name | WESLEY HOUSE ALF #3
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 28502 TALL GRASS DR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-5829
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Country | US
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Telephone | 813-991-5071
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Fax |
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Provider Business Mailing Address
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Address Line | 28502 TALL GRASS DR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-5829
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Country | US
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Telephone | 813-991-4133
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Fax |
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Authorized Official
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Title or Position | OWNER ADMINISTRATOR
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Name | MRS. LOLA JEYEDE
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Credential |
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Telephone | 813-469-4496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AL11126
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL11126
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License Number State | FL
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