Provider Demographics
NPI:1770586604
Name:WILMOT CARE CENTER
Entity type:Organization
Organization Name:WILMOT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:POND
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:2005-05-24
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10712314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0160432Medicaid
SD0160432Medicaid