Provider Demographics
NPI:1639277577
Name:WILMOT CARE CENTER
Entity Type:Organization
Organization Name:WILMOT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-938-4418
Mailing Address - Street 1:501 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMOT
Mailing Address - State:SD
Mailing Address - Zip Code:57279-2232
Mailing Address - Country:US
Mailing Address - Phone:605-938-4418
Mailing Address - Fax:605-938-4412
Practice Address - Street 1:501 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMOT
Practice Address - State:SD
Practice Address - Zip Code:57279-2232
Practice Address - Country:US
Practice Address - Phone:605-938-4418
Practice Address - Fax:605-938-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10712310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9571652Medicaid