- Enrollment id
- O20180813003372
- Enrollment state
- VA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1477543890
- Multiple npi flag
- N
- Ccn
- 495350
- Associate id
- 9436408127
- Organization name
- WISE LIFE CARE, LLC
- Doing business as name
- HERITAGE HALL - WISE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- HERITAGE HALL WISE
- Affiliation entity name
- HERITAGE HALL
- Affiliation entity id
- 265
- Address line 1
- 9434 COEBURN MOUNTAIN RD
- City
- WISE
- State
- VA
- Zip code
- 242935944