Healthcare Provider Details

I. General information

NPI: 1972261287
Provider Name (Legal Business Name): WILSHIRE OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/03/2021
Certification Date: 11/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE MEADOWVIEW DR
LEES SUMMIT MO
64064-1983
US

IV. Provider business mailing address

311 BLVD OF THE AMERICAS SUITE 201
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-9866
  • Fax:
Mailing address:
  • Phone: 908-621-1184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JACQUES WOLF
Title or Position: MANAGER
Credential:
Phone: 908-621-1184