MEDICARE: THE WESLEY HOSPICE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1710431598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WESLEY HOSPICE CARE LLC

Provider Business Mailing Address
First Line	:	1500 DISTRICT AVE
Second Line	:
City	:	BURLINGTON
State	:	MA
Zip	:	01803-5069
Country	:	US
Telephone Number	:	678-502-0146
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 DISTRICT AVE
Second Line	:
City	:	BURLINGTON
State	:	MA
Zip	:	01803-5069
Country	:	US
Telephone Number	:	678-502-0146
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ADRIAN HOLLINGSHED
Credential	:
Telephone Number	:	678-502-0146

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	08/09/2016

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