Provider Demographics
NPI:1629280961
Name:ARC WILORA ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:ARC WILORA ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP & CHIEF ACCOUNTING OFF
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-564-8190
Mailing Address - Street 1:6053 WILORA LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-2833
Mailing Address - Country:US
Mailing Address - Phone:704-537-8848
Mailing Address - Fax:704-537-0118
Practice Address - Street 1:6053 WILORA LAKE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-2833
Practice Address - Country:US
Practice Address - Phone:704-537-8848
Practice Address - Fax:704-537-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL060060310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility