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General NPI Number Information
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NPI Number | 1841969458
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Entity Type | Organization
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Legal Business Name | WALLACE OPCO, LLC
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 4026 NC- 11 SOUTH
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City | WALLACE
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State | NC
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Zip | 28466
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Country | US
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Telephone | 910-285-9050
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2568
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City | HICKORY
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State | NC
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Zip | 28603-2568
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Country | US
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Telephone | 828-322-5535
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. CHARLES E TREFZGER JR.
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Credential |
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Telephone | 828-322-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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