NPIMap

Organization Active NPI

Wise Life Care, LLC

Doing business as Heritage Hall - Wise

  • Skilled Nursing Facility
  • Wise, VA
National Provider Identifier
1477543890
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
Doing business as
Heritage Hall - Wise
Practice address
9434 Coeburn Mountain Rd
Wise, VA 24293
Phone
(276) 328-2721
Fax
(276) 328-1463
NPI assigned
Oct 26, 2005
Last updated
Nov 25, 2024By the provider in NPPES
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

Mailing address

3131 Electric Rd
Roanoke, VA 24018-6427
Phone (540) 774-4263

Other names 1

  • Heritage Hall - Wise Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180813003372 VA Part A Provider - Skilled Nursing Facility 9436408127 Practice locations: Wise, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477543890. Details of each certification follow.

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
LLCProprietary
Enrollment address
9434 Coeburn Mountain Rd
Wise, VA 24293-5944
Nursing home name
HERITAGE HALL WISE
Affiliated entity
HERITAGE HALL

Care Compare: Nursing home

Medicare Care Compare
Listed as
Heritage Hall WiseCCN 495350 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
9787.0 residents per day on average
Chain
Heritage Hall15 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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.

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
William B Hopkins Individual Corporate DirectorDirector Jan 22, 2018 50%
Brad Dalton Individual Corporate OfficerSecretary Jul 11, 2024
Operational/Managerial Control Jul 11, 2024
Adp of the SNF Jul 11, 2024
Dustin Jackson Individual Operational/Managerial Control Oct 2, 2024
Adp of the SNF Oct 2, 2024
Vijay N Kumar Individual Operational/Managerial Control Oct 2, 2024
Adp of the SNF Oct 2, 2024
Cassandra Gallant Individual Operational/Managerial Control Jul 11, 2024
Thomas East Individual Corporate OfficerPresident & Ceo Jan 22, 2018 100%
Corporate DirectorPresident & Ceo Jan 22, 2018 50%
Operational/Managerial Control Apr 21, 2014
Adp of the SNF Apr 21, 2014
American Healthcare LLC Organization, Roanoke, VA LLC, Management services company 5% Or Greater Direct Ownership Interest Jan 22, 2018
Operational/Managerial Control Jan 22, 2018
Adp of the SNF Jan 22, 2018
Robert Dalton Individual Corporate OfficerCfo Jan 22, 2018
Operational/Managerial Control Apr 21, 2014
Adp of the SNF Apr 21, 2014

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 14

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 14

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1477543890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 ELECTRIC RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240186427",
            "telephone_number": "540-774-4263",
            "fax_number": "540-774-0780"
        },
        {
            "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": "24293",
            "telephone_number": "276-328-2721",
            "fax_number": "276-328-1463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISE LIFE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Hall - Wise",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wise, VA

Sources for this page

Verify at the official NPI Registry.