NPIMap

Organization Active NPI

Wise Life Care, LLC

  • Skilled Nursing Facility
  • Wise, VA
National Provider Identifier
1225520232
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH2583 Issued in VA
Legal business name
WISE LIFE CARE, LLC
Practice address
9434 Coeburn Mountain Rd
Wise, VA 24293-5944
Phone
(276) 328-2721
Fax
(276) 328-1463
NPI assigned
Jun 5, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Authorized official

Name
Cassandra Gallant
Title
Compliance & Privacy Officer
Phone
(540) 774-4263

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NH2583 VA Primary

Addresses

Primary practice location

9434 Coeburn Mountain Rd
Wise, VA 24293-5944

Mailing address

PO Box 1009
Wise, VA 24293-1009
Phone (276) 328-2721

Other identifiers 3

IdentifierTypeStateIssuer
180512OtherANTHEM BCBS
4953509MedicaidVA
200515608OtherFEDERAL BLACK LUNG

Other names 1

  • Heritage Hall - Wise Doing business as

National Provider Directory

National Provider Directory
Tax ID family
American Healthcare LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1225520232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1009",
            "city": "WISE",
            "state": "VA",
            "postal_code": "242931009",
            "telephone_number": "276-328-2721",
            "fax_number": "276-328-1463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9434 COEBURN MOUNTAIN RD",
            "city": "WISE",
            "state": "VA",
            "postal_code": "242935944",
            "telephone_number": "276-328-2721",
            "fax_number": "276-328-1463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISE LIFE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-05",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "GALLANT",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "COMPLIANCE & PRIVACY OFFICER",
        "authorized_official_telephone_number": "540-774-4263"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VA",
            "license": "NH2583",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "180512",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4953509",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "200515608",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Hall - Wise",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heritage Hall - Wise",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wise, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.