Healthcare Provider Details

I. General information

NPI: 1992942973
Provider Name (Legal Business Name): WILKESBORO LIVIG CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 RESTHOME RD
WILKESBORO NC
28697-7145
US

IV. Provider business mailing address

495 ZION HILL RD
MARION NC
28752-6304
US

V. Phone/Fax

Practice location:
  • Phone: 336-973-3890
  • Fax: 336-973-3042
Mailing address:
  • Phone: 828-738-3053
  • Fax: 828-738-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHAL097012
License Number StateNC

VIII. Authorized Official

Name: MS. MARTHA H WILSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 828-738-3053