# WISE LIFE CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Heritage Hall - Wise
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477543890
- **Authorized official:** CASSANDRA GALLANT (COMPLIANCE & PRIVACY OFFICER)
- **Authorized official phone:** (540) 774-4263

## Contact information

- **Practice address:** 9434 COEBURN MOUNTAIN RD, WISE, VA 24293
- **Practice address phone:** (276) 328-2721
- **Practice address fax:** (276) 328-1463
- **Mailing address:** 3131 ELECTRIC RD, ROANOKE, VA 24018-6427
- **Mailing address phone:** (540) 774-4263
- **Mailing address fax:** (540) 774-0780

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH2583 | VA | Yes |

## Other

- **Enumeration date:** 10/26/2005
- **Last updated:** 11/25/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 180512 | ANTHEM BCBS PROVIDER ID | VA |
| 01 | — | 200515608 | FEDERAL BLACK LUNG ID | VA |
| 05 | — | 4953509 | — | VA |