NPIMap

Organization Active NPI

6001 Wilora Lake Road Opco LLC

Doing business as Wilora Lake Healthcare

  • Skilled Nursing Facility
  • Charlotte, NC
National Provider Identifier
1831907781
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
6001 WILORA LAKE ROAD OPCO LLC
Doing business as
Wilora Lake Healthcare
Practice address
6001 Wilora Lake Rd
Charlotte, NC 28212-2833
Phone
(704) 563-2922
Fax
(704) 563-2814
NPI assigned
Dec 24, 2024
Last updated
Mar 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Authorized official

Name
Tiffany Hoback
Title
Manager
Phone
(770) 698-9040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

6001 Wilora Lake Rd
Charlotte, NC 28212-2833

Mailing address

6001 Wilora Lake Rd
Charlotte, NC 28212-2833
Phone (704) 563-2922

Other names 1

  • Wilora Lake Healthcare Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other Synergy Healthcare Services

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250812001976 NC Part A Provider - Skilled Nursing Facility 3072011758 Practice locations: Charlotte, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831907781. Details of each certification follow.

Skilled nursing facility certification: CCN 345473

Legal name
6001 WILORA LAKE ROAD OPCO LLC
Doing business as
WILORA LAKE HEALTHCARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 26, 1995
Last certification
Feb 20, 2025
Beds
70
Ownership / control type
Corporation
Multi-facility organization
Avardis Health
Organization structure
LLC
Enrollment address
6001 Wilora Lake Rd
Charlotte, NC 28212-2833
Nursing home name
WILORA LAKE HEALTHCARE
Affiliated entity
AVARDIS HEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
Wilora Lake HealthcareCCN 345473 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Sep 26, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7061.4 residents per day on average
Chain
Avardis Health38 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Organization, Atlanta, GA LLC, For-profit Adp of the SNF Apr 21, 2025
Charlotte Parentco LLC Organization, Atlanta, GA LLC, Holding company, For-profit, Owned by another organization or individual Direct Ownership Interest Jun 1, 2025 100%
Nu C II Irrevocable Trust Organization, New York, NY Holding company, For-profit Indirect Ownership Interest Jun 1, 2025 50%
Mecklenburg Holdco LLC Organization, Atlanta, GA LLC, Holding company, For-profit, Owned by another organization or individual Indirect Ownership Interest Jun 1, 2025 100%
Ncop Holdco LLC Organization, Atlanta, GA LLC, Holding company, For-profit, Owned by another organization or individual Indirect Ownership Interest Jun 1, 2025 100%
Keizma Hill Individual Operational/Managerial Control May 1, 2025
Adp of the SNF May 1, 2025
Organization, Kennett Square, PA LLC, For-profit Adp of the SNF Apr 25, 2025
SNF Care Centers LLC Organization, Atlanta, GA LLC, Holding company, For-profit, Owned by another organization or individual Indirect Ownership Interest Jun 1, 2025 100%
SNF MGR LLC Organization, Atlanta, GA LLC, Management services company, For-profit Operational/Managerial Control May 1, 2025
Adp of the SNF Apr 21, 2025
Brandi H Semones Individual Operational/Managerial Control May 1, 2025
Managing Control - Governing Body May 1, 2025
Adp of the SNF May 1, 2025
Organization, Orlando, FL For-profit Adp of the SNF Apr 21, 2025
Zenith Holdco II LLC Organization, Atlanta, GA LLC, Holding company, For-profit, Owned by another organization or individual Indirect Ownership Interest Jun 1, 2025 100%
Organization, Woonsocket, RI LLC, For-profit Adp of the SNF Apr 21, 2025
Tiffany Hoback Individual Operational/Managerial Control May 1, 2025
Managing Control - Governing Body May 1, 2025
Adp of the SNF May 1, 2025
Zenith Holdco LLC Organization, Atlanta, GA LLC, Holding company, For-profit, Owned by another organization or individual Indirect Ownership Interest Jun 1, 2025 100%
Tequilla Jones Individual Operational/Managerial Control May 1, 2025
Adp of the SNF May 1, 2025
Dereca J Bryant Individual Operational/Managerial Control May 1, 2025
Adp of the SNF May 1, 2025
Thad a Clements Individual Operational/Managerial Control May 1, 2025
Adp of the SNF May 1, 2025
Nu C Irrevocable Trust Organization, New York, NY Holding company, For-profit Indirect Ownership Interest Jun 1, 2025 50%
FC Encore Charlotte, LLC Organization, Hunt Valley, MD LLC, For-profit, Real estate investment trust (REIT), Owned by another organization or individual 5% Or Greater Security Interest May 1, 2025
Adp of the SNF May 1, 2025

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 41

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

View all 41

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1734998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1831907781",
    "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": "6001 WILORA LAKE ROAD OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-24",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A",
        "authorized_official_last_name": "HOBACK",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-698-9040"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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",
            "affiliationName": "Synergy Healthcare Services",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "850 Concourse Pkwy S Ste 250",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Wilora Lake Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.