Provider Demographics
NPI:1588800551
Name:WNC ASSISTED LIVING
Entity Type:Organization
Organization Name:WNC ASSISTED LIVING
Other - Org Name:FLETCHER FAMILY CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYREE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:828-606-0248
Mailing Address - Street 1:80 FORGE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MILLS RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28759-8600
Mailing Address - Country:US
Mailing Address - Phone:828-890-8355
Mailing Address - Fax:828-651-9169
Practice Address - Street 1:159 AMBLE LN
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-9555
Practice Address - Country:US
Practice Address - Phone:828-687-8388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-045-097310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility