Organization
WESLEY GLEN MINISTRIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM OLIVER DR. (PRESIDENT/CEO)
(478) 471-3711
Entity
Organization
Contact information
Practice address
4580 N MUMFORD RD, MACON, GA 31210-4033
(478) 471-3711
Mailing address
4580 N MUMFORD RD, MACON, GA 31210-4033
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000754916
—
GA
Enumeration date
07/24/2014
Last updated
07/24/2014
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