WISHING WELL MANOR, INC. (NPI# 1073501466) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073501466 |
| Entity Type | Organization |
| Organization Name | WISHING WELL MANOR, INC. |
| Other Organization Name | WISHING WELL MANOR |
| Practice Address |
1543 Country Club Rd Fairmont WV 26554-1306 |
| Practice Telephone | 3043668414 |
| Practice Fax Number | 3043632384 |
| Mailing Telephone | 3043668414 |
| Mailing Fax Number | 3043632384 |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. CARLENE S. MOORE (CONTROLLER) |
| Authorized Official Telephone | 3043668414 |
| Authorized Official Credential | NHA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 314000000X | Skilled Nursing Facility | 59 | WV | Nursing & Custodial Care Facilities |
| X | 310400000X | Assisted Living Facility | 132 | WV | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | 0003893000 | 05 |
| Other Name | Type Code |
|---|---|
| WISHING WELL MANOR | Doing Business As Name - Organization |
| Street Address |
1543 COUNTRY CLUB RD |
| City | FAIRMONT |
| State | WV |
| Zip Code | 26554-1306 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700486008 | Randi Dawnielle Davis | Nurse Practitioner | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2020-10-27 |
| 1083277222 | Breanna Marie Kalanish | Occupational Therapy Assistant | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2019-04-14 |
| 1124597935 | Kira Leigh Nixon | Occupational Therapy Assistant | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2018-11-21 |
| 1659860328 | Lara Nicole Angelilli | Speech-Language Pathologist | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2018-05-08 |
| 1487181095 | Debbie Stahl | Physical Therapy Assistant | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2017-05-12 |
| 1609270586 | Trinity Celapino | Physical Therapy Assistant | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2014-10-21 |
| 1649588948 | Ashley Nicole Kallop | Speech-Language Pathologist | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2010-09-21 |
| 1699081265 | Erica Nicole Mouser | Occupational Therapist | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2010-08-20 |
| 1447565973 | Samantha Jo Stickley | Physical Therapist | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2010-08-09 |
| 1972732816 | Lyndsay Marie Shaffer | Physical Therapist | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2009-07-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801497680 | Vanquisha Clay | Technician | 118 Conaway St, Fairmont, WV 26554 | 2020-11-06 |
| 1851903363 | Denise S Greer | Technician | 1029 Prickett Road, Fairmont, WV 26554 | 2020-08-18 |
| 1730790775 | Darla Lee Mcrobie | Technician | 105 C'anna Square, Fairmont, WV 26554 | 2020-08-13 |
| 1376025718 | Jason Batten | Counselor | 621 Maryland Ave, Fairmont, WV 26554 | 2018-09-02 |
| 1437669066 | Ultimate Health & Wellness, LLC | Naturopath | 2862 Whitehall Blvd, Whitehall, WV 26554 | 2017-10-10 |
| 1457872376 | Michele R Lilley | Nurse Practitioner | 177 Middletown Rd, Ste1, Upc Whitehall Medical, Fairmont, WV 26554 | 2017-06-30 |
| 1477906154 | Rebecca Hayes-merrill | Counselor | 212 Adams St., 3rd Floor, Fairmont, WV 26554 | 2016-07-19 |
| 1790173417 | Dennis Michael Lynch | Counselor | 5 Turf Lane, Fairmont, WV 26554 | 2015-01-05 |
| 1336558725 | Nicole Savage | Home Health Aide | 122 Abbott St, Fairmont, WV 26554 | 2014-08-11 |
| 1124434550 | Achuta Ram Aynampudi | Psychiatry & Neurology | 100 Stoney Hill Rd, Fairmont, WV 26554 | 2014-07-07 |
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| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053542555 | Arbors of Fairmont | Skilled Nursing Facility | 1700 Big Tree Dr Apt 79, Fairmont, WV 26554-8310 | 2009-07-31 |
| 1346274370 | Kaufman Street Wv LLC | Skilled Nursing Facility | 130 Kaufman Dr, Fairmont, WV 26554-2179 | 2006-07-10 |
| 1437134004 | City of Fairmont Nebraska - Fairview Manor | Skilled Nursing Facility | 255 F St, Fairmont, NE 68354-9771 | 2005-12-07 |
| 1316935703 | Wishing Well Nursing Home, Inc. | Skilled Nursing Facility | 1539 Country Club Rd, Fairmont, WV 26554-1306 | 2005-10-10 |
| 1831191147 | Lakeview Methodist Health Care Center | Skilled Nursing Facility | 610 Summit Dr, Fairmont, MN 56031-2247 | 2005-06-01 |
| 1861998486 | Guardian Elder Care At Fairmont LLC | Skilled Nursing Facility | 130 Kaufman Dr, Fairmont, WV 26554-2179 | 2018-04-03 |
| 1629584727 | Qls Fairmont LLC | Skilled Nursing Facility | 130 Kaufman Dr, Fairmont, WV 26554-2179 | 2017-12-27 |
| 1326439522 | Oak Hrc Fairmont LLC | Skilled Nursing Facility | 130 Kaufman Dr, Fairmont, WV 26554-2179 | 2015-02-10 |
| 1578709341 | 1539 Country Club Road Operations LLC | Skilled Nursing Facility | 1539 Country Club Rd, Fairmont, WV 26554-1306 | 2008-12-30 |
| 1396981064 | 1543 Country Club Road Manor Operations LLC | Skilled Nursing Facility | 1543 Country Club Rd, Fairmont, WV 26554-1306 | 2008-12-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.