Basic Information
| Provider Information | |||||||||
| NPI: | 1982242681 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILKESBORO ASSISTED LIVING CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 229 AIRPORT RD STE 7-104 | ||||||||
| Address2: | |||||||||
| City: | ARDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287046402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196089123 | ||||||||
| FaxNumber: | 9198829771 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 OLD BRICKYARD RD | ||||||||
| Address2: | |||||||||
| City: | NORTH WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286598971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366672020 | ||||||||
| FaxNumber: | 3366675357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2019 | ||||||||
| LastUpdateDate: | 12/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | SPRENGER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9196089123 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 12/13/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | Y | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
No ID Information.