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General NPI Number Information
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NPI Number | 1902901861
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Entity Type | Organization
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Legal Business Name | WILSHIRE NURSING CENTER LLC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 505 E WILSHIRE BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73105-1011
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Country | US
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Telephone | 405-478-0531
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Fax | 405-478-3520
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Provider Business Mailing Address
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Address Line | 505 E WILSHIRE BLVD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73105-1011
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Country | US
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Telephone | 405-478-0531
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Fax | 405-478-3520
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Authorized Official
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Title or Position | MANAGER
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Name | MIKE DIMOND
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Credential |
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Telephone | 405-943-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH5541-5541
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License Number State | OK
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