Wishing Well Nursing Home, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

62 Issued in WV

Legal business name

WISHING WELL NURSING HOME, INC.

Doing business as

Wishing Well Health Center

Practice address

1539 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 1

Addresses

Other identifiers 1

Other names 1

• WISHING WELL HEALTH CENTER 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": "1598054400000",
    "number": "1316935703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1539 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": "1539 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 NURSING HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-10",
        "last_updated": "2020-08-22",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WV",
            "license": "62",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0003887000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WISHING WELL HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cheryl Benita Wingate, M.D.
• Frank Vernon Winiavski
• Kyle Edward Wise
• Jessica Wisenbaler
• Wishing Well Manor, Inc. (Wishing Well Manor)
• Laura Elizabeth Withers-Boyles, DDS
• Olivia Wix
• Rease Wix
• Ashley Wolfe-Merrifield
• Courtney Brooke Wolfe

• Skilled Nursing Facility in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Skilled Nursing Facility in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.