Provider Demographics
NPI:1417991647
Name:WISHEK HOME FOR THE AGED
Entity Type:Organization
Organization Name:WISHEK HOME FOR THE AGED
Other - Org Name:WISHEK LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALWEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-452-2333
Mailing Address - Street 1:400 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WISHEK
Mailing Address - State:ND
Mailing Address - Zip Code:58495-0187
Mailing Address - Country:US
Mailing Address - Phone:701-452-2333
Mailing Address - Fax:701-452-2335
Practice Address - Street 1:400 S 4TH ST
Practice Address - Street 2:
Practice Address - City:WISHEK
Practice Address - State:ND
Practice Address - Zip Code:58495-7430
Practice Address - Country:US
Practice Address - Phone:701-452-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1059A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30039Medicaid
355066Medicare ID - Type Unspecified