Basic Information
| Provider Information | |||||||||
| NPI: | 1750529129 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WISH-I-AH SKILLED NURSING & WELLNESS CENTRE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WISH-I-AH HEALTHCARE & WELLNESS CENTRE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35680 WISH I AH RD | ||||||||
| Address2: | |||||||||
| City: | AUBERRY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936029615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598552211 | ||||||||
| FaxNumber: | 3236341943 | ||||||||
| Practice Location | |||||||||
| Address1: | 35680 WISH I AH RD | ||||||||
| Address2: | |||||||||
| City: | AUBERRY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936029615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598552211 | ||||||||
| FaxNumber: | 3236341943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2009 | ||||||||
| LastUpdateDate: | 01/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | KOLODNY | ||||||||
| AuthorizedOfficialFirstName: | CHAIM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3236341940 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NHA, CMC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 040000167 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | ZZR18257G | 05 | CA | MEDICAID |