Healthcare Provider Details

I. General information

NPI: 1982242681
Provider Name (Legal Business Name): WILKESBORO ASSISTED LIVING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 OLD BRICKYARD RD
NORTH WILKESBORO NC
28659-8971
US

IV. Provider business mailing address

229 AIRPORT RD STE 7-104
ARDEN NC
28704-6402
US

V. Phone/Fax

Practice location:
  • Phone: 336-667-2020
  • Fax: 336-667-5357
Mailing address:
  • Phone: 919-608-9123
  • Fax: 919-882-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER JOHN SPRENGER
Title or Position: MANAGER
Credential:
Phone: 919-608-9123