Organization
WISHING WELL MANOR, INC.
Active
Other names
WISHING WELL MANOR
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARLENE S. MOORE NHA (CONTROLLER)
(304) 366-8414
Entity
Organization
Contact information
Practice address
1543 COUNTRY CLUB RD, FAIRMONT, WV 26554-1306
(304) 366-8414
(304) 363-2384
Mailing address
1543 COUNTRY CLUB RD, FAIRMONT, WV 26554-1306
(304) 366-8414
(304) 363-2384
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
132
WV
314000000X
Skilled Nursing Facility
59
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0003893000
—
WV
Enumeration date
10/10/2005
Last updated
09/11/2025
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