Provider Demographics
NPI:1871786616
Name:WESLEYAN HOME CARE, INC.
Entity type:Organization
Organization Name:WESLEYAN HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDIRI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-479-2273
Mailing Address - Street 1:410 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-3055
Mailing Address - Country:US
Mailing Address - Phone:410-479-2273
Mailing Address - Fax:410-479-0180
Practice Address - Street 1:410 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-3055
Practice Address - Country:US
Practice Address - Phone:410-479-2273
Practice Address - Fax:410-479-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05AL026310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5510260000Medicaid