Provider Demographics
NPI:1245343334
Name:WILMON CORPORATION
Entity type:Organization
Organization Name:WILMON CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PREIMESBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:951-685-7474
Mailing Address - Street 1:8951 GRANITE HILL DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-1104
Mailing Address - Country:US
Mailing Address - Phone:951-685-7474
Mailing Address - Fax:951-685-3047
Practice Address - Street 1:8951 GRANITE HILL DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-1104
Practice Address - Country:US
Practice Address - Phone:951-685-7474
Practice Address - Fax:951-685-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000213314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC90047FMedicaid
CA555884Medicare Oscar/Certification