# WILSHIRE NURSING CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Grace Living Center - Wilshire, The Wilshire Skilled Nursing and Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902901861
- **Authorized official:** MIKE DIMOND (MANAGER)
- **Authorized official phone:** (405) 943-1144

## Contact information

- **Practice address:** 505 E WILSHIRE BLVD, OKLAHOMA CITY, OK 73105-1011
- **Practice address phone:** (405) 478-0531
- **Practice address fax:** (405) 478-3520
- **Mailing address:** 505 E WILSHIRE BLVD, OKLAHOMA CITY, OK 73105-1011
- **Mailing address phone:** (405) 478-0531
- **Mailing address fax:** (405) 478-3520

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH5541-5541 | OK | Yes |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 09/29/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100776920A | — | OK |