Provider Demographics
NPI:1194283663
Name:WESLEYAN VILLAGE
Entity type:Organization
Organization Name:WESLEYAN VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-222-5275
Mailing Address - Street 1:807 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-5898
Mailing Address - Country:US
Mailing Address - Phone:440-284-9000
Mailing Address - Fax:440-284-9636
Practice Address - Street 1:807 WEST AVE
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5898
Practice Address - Country:US
Practice Address - Phone:440-284-9000
Practice Address - Fax:440-284-9636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2527751Medicaid