NPIMap

Organization Active NPI

Sovran Senior Living, LLC

Doing business as Waylin Life Care Center

  • Assisted Living Facility
  • Mount Olive, NC
National Provider Identifier
1508134685
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
SOVRAN SENIOR LIVING, LLC
Doing business as
Waylin Life Care Center
Practice address
600 Smith Chapel Rd
Mount Olive, NC 28365-2632
Phone
(919) 658-6501
Fax
(919) 658-6799
NPI assigned
Dec 5, 2011
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Ms. Dorene M Ford
Title
Director of Mis
Phone
(239) 659-4900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

600 Smith Chapel Rd
Mount Olive, NC 28365-2632

Mailing address

1400 Centrepark Blvd Ste 810
West Palm Beach, FL 33401-7412
Phone (239) 659-4900

Other names 2

  • WAYLIN LIFE CARE CENTER Doing business as
  • SSL OF MOUNT OLIVE NC LLC Other name

National Provider Directory

National Provider Directory
Tax ID family
Sovran Senior Living 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.

Locations

600 Smith Chapel Rd
Mount Olive, NC 28365
Phone (919) 658-6501

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1323043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1508134685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 CENTREPARK BLVD STE 810",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334017412",
            "telephone_number": "239-659-4900",
            "fax_number": "239-963-3410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 SMITH CHAPEL RD",
            "city": "MOUNT OLIVE",
            "state": "NC",
            "postal_code": "283652632",
            "telephone_number": "919-658-6501",
            "fax_number": "919-658-6799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOVRAN SENIOR LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-05",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "DORENE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR OF MIS",
        "authorized_official_telephone_number": "239-659-4900",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WAYLIN LIFE CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SSL OF MOUNT OLIVE NC LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SSL OF MOUNT OLIVE NC LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mount Olive, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.