Organization
WESLEY HOUSE AIF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LOLA I JEGREDE (ADMINISTRATOR)
(813) 469-4496
Entity
Organization
Contact information
Practice address
1500 MARIMILLIAN DR, WESLEY CHAPEL, FL 33543
(813) 770-1605
Mailing address
1500 MARIMILLIAN DR, WESLEY CHAPEL, FL 33543
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
AL9256
FL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
AL9256
FL
347C00000X
Private Vehicle
Primary
AL9256
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140033900
PBCALL
FL
01
—
687743296
LESHAB
FL
Enumeration date
01/28/2008
Last updated
01/28/2008
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