Healthcare Provider Details

I. General information

NPI: 1902901861
Provider Name (Legal Business Name): WILSHIRE NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E WILSHIRE BLVD
OKLAHOMA CITY OK
73105-1011
US

IV. Provider business mailing address

505 E WILSHIRE BLVD
OKLAHOMA CITY OK
73105-1011
US

V. Phone/Fax

Practice location:
  • Phone: 405-478-0531
  • Fax: 405-478-3520
Mailing address:
  • Phone: 405-478-0531
  • Fax: 405-478-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH5541-5541
License Number StateOK

VIII. Authorized Official

Name: MIKE DIMOND
Title or Position: MANAGER
Credential:
Phone: 405-943-1144