Wise Life Care, LLC
Organization Active NPI Skilled Nursing Facility · Wise, VA
NPI 1477543890 · NPPES record last updated Nov 25, 2024
Key facts
- NPI
- 1477543890
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- NH2583 (VA)
- Legal business name
- WISE LIFE CARE, LLC
- Practice address
- 9434 Coeburn Mountain Rd
Wise, VA 24293 - Phone
- (276) 328-2721
- Fax
- (276) 328-1463
- NPI assigned
- Oct 26, 2005
- Organization subpart
- No
Authorized official
- Name
- Cassandra Gallant
- Title
- Compliance & Privacy Officer
- Phone
- (540) 774-4263
Owners & managing parties with NPI records 1
-
Vijay N Kumar, M.D.,
Corporate family (same tax ID) 1
Facilities with the same owner 14
Affiliated clinicians 2
-
Vijay N Kumar, M.D.,
Medicare Care Compare: Nursing home
- Listed as
- Heritage Hall Wise
- Overall star rating
- ★★★★☆ 4 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Mar 1, 2001
- Medicare certification status
- Active
- Certified beds
- 97 · 87.0 residents per day on average
- Chain
- Heritage Hall
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Skilled nursing facility certification: CCN 495350
- Legal name
- WISE LIFE CARE, LLC
- Doing business as
- HERITAGE HALL - WISE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 1, 2001
- Last certification
- Aug 1, 2024
- Beds
- 97
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Proprietary
- Enrollment address
- 9434 Coeburn Mountain Rd
Wise, VA 24293-5944 - Nursing home name
- HERITAGE HALL WISE
- Affiliated entity
- HERITAGE HALL
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| William B Hopkins |
Corporate Director |
Jan 22, 2018 | 50% |
| Brad Dalton |
Corporate Officer |
Jul 11, 2024 | |
| Operational/Managerial Control | Jul 11, 2024 | ||
| Adp of the SNF | Jul 11, 2024 | ||
| Dustin Jackson |
Operational/Managerial Control | Oct 2, 2024 | |
| Adp of the SNF | Oct 2, 2024 | ||
| Vijay N Kumar |
Operational/Managerial Control | Oct 2, 2024 | |
| Adp of the SNF | Oct 2, 2024 | ||
| Cassandra Gallant |
Operational/Managerial Control | Jul 11, 2024 | |
| Thomas East |
Corporate Officer |
Jan 22, 2018 | 100% |
| Corporate Director |
Jan 22, 2018 | 50% | |
| Operational/Managerial Control | Apr 21, 2014 | ||
| Adp of the SNF | Apr 21, 2014 | ||
| American Healthcare LLC |
5% Or Greater Direct Ownership Interest | Jan 22, 2018 | |
| Operational/Managerial Control | Jan 22, 2018 | ||
| Adp of the SNF | Jan 22, 2018 | ||
| Robert Dalton |
Corporate Officer |
Jan 22, 2018 | |
| Operational/Managerial Control | Apr 21, 2014 | ||
| Adp of the SNF | Apr 21, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180813003372 | VA | Part a Provider - Skilled Nursing Facility | 9436408127 | Practice locations: Wise, VA |
National Provider Directory
- Tax ID family
- American Healthcare LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NH2583 | VA | Yes |
Addresses
Primary practice location
9434 Coeburn Mountain Rd
Wise, VA 24293
Mailing address
3131 Electric Rd
Roanoke, VA 24018-6427
Phone (540) 774-4263
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200515608 | Other | VA | FEDERAL BLACK LUNG ID |
| 180512 | Other | VA | ANTHEM BCBS PROVIDER ID |
| 4953509 | Medicaid | VA |
Other names
- Heritage Hall - Wise
Other providers in Wise, VA
- Wise Choice Home Health Inc.
- Wise County Dental Clinic
- Wise County Public Schools
- Wise Economy Drug Inc
- Wise Life Care, LLC
- Wise Medical Rentals
- Wise Rescue Squad Inc
- Jewell Bevins Worley
- Wanda Sue Wright
- Ryan Christopher Yeates
All providers in Wise, VA · Skilled Nursing Facility in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.