Provider Demographics
NPI:1013280171
Name:WESLEY HOUSE FAMILY SERVICES
Entity type:Organization
Organization Name:WESLEY HOUSE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-809-5000
Mailing Address - Street 1:1304 TRUMAN AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-7268
Mailing Address - Country:US
Mailing Address - Phone:305-809-5000
Mailing Address - Fax:305-809-5010
Practice Address - Street 1:3114 FLAGLER AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4602
Practice Address - Country:US
Practice Address - Phone:305-809-5000
Practice Address - Fax:305-809-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management