Healthcare Provider Details

I. General information

NPI: 1205575511
Provider Name (Legal Business Name): WLC OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 S EAST RAILROAD ST
WALLACE NC
28466-2091
US

IV. Provider business mailing address

311 BOULEVARD OF THE AMERICAS SUITE 504
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 910-285-9700
  • Fax:
Mailing address:
  • Phone: 908-506-4204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TZVI ALTER
Title or Position: CEO
Credential:
Phone: 908-506-4204