Wishing Well Manor, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

132 Issued in WV

Legal business name

WISHING WELL MANOR, INC.

Doing business as

Wishing Well Manor

Practice address

1543 Country Club Rd
Fairmont, WV 26554-1306

Phone

(304) 366-8414

Fax

(304) 363-2384

NPI assigned

Oct 10, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Carlene S. Moore, NHA

Title

Controller

Phone

(304) 366-8414

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• WISHING WELL MANOR Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1073501466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1543 COUNTRY CLUB RD",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265541306",
            "telephone_number": "304-366-8414",
            "fax_number": "304-363-2384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1543 COUNTRY CLUB RD",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265541306",
            "telephone_number": "304-366-8414",
            "fax_number": "304-363-2384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISHING WELL MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-10",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "CARLENE",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "304-366-8414",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WV",
            "license": "132",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WV",
            "license": "59",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0003893000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WISHING WELL MANOR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tracy Ann Wine, MSW, LGSW
• Cheryl Benita Wingate, M.D.
• Frank Vernon Winiavski
• Kyle Edward Wise
• Jessica Wisenbaler
• Wishing Well Nursing Home, Inc. (Wishing Well Health Center)
• Laura Elizabeth Withers-Boyles, DDS
• Olivia Wix
• Rease Wix
• Ashley Wolfe-Merrifield

• Assisted Living Facility in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Assisted Living Facility in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.