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General NPI Number Information
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NPI Number | 1477543890
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Entity Type | Organization
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Legal Business Name | WISE LIFE CARE, LLC
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 9434 COEBURN MOUNTAIN RD
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City | WISE
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State | VA
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Zip | 24293
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Country | US
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Telephone | 276-328-2721
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Fax | 276-328-1463
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Provider Business Mailing Address
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Address Line | 3131 ELECTRIC RD
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City | ROANOKE
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State | VA
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Zip | 24018-6427
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Country | US
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Telephone | 540-774-4263
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Fax | 540-774-0780
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Authorized Official
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Title or Position | COMPLIANCE & PRIVACY OFFICER
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Name | CASSANDRA GALLANT
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Credential |
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Telephone | 540-774-4263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH2583
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License Number State | VA
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