Wilora Lake Healthcare LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH572 Issued in NC

Legal business name

WILORA LAKE HEALTHCARE LLC

Practice address

6001 Wilora Lake Rd
Charlotte, NC 28212-2833

Phone

(704) 563-2922

Fax

(704) 563-2814

NPI assigned

Jun 12, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tim Lehner

Title

Manager

Phone

(770) 698-9040

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wilora Lake Healthcare Center Doing business as

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1215979059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6001 WILORA LAKE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282122833",
            "telephone_number": "704-563-2922",
            "fax_number": "704-563-2814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6001 WILORA LAKE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282122833",
            "telephone_number": "704-563-2922",
            "fax_number": "704-563-2814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILORA LAKE HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "LEHNER",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-698-9040"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215979059",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "800 Concourse Pkwy S Ste 200",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Wilora Lake Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wilora Lake Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Willows Nest
• Lisa Wills
• Tanija S Wills
• Marion Ellen Wilm, OTR/L
• Joya D Wilmot
• Elizabeth Oludayo Wilson-Durham, FNP
• Roxanne Annesa Wilson-Miller, LCSW
• Heather Dawn Wilson-Shelton
• Aaron Everett Wilson, MD
• Acacia Wilson

• Skilled Nursing Facility in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.