Provider Demographics
NPI:1891531281
Name:WILLEM SENIOR ALLIANCE
Entity type:Organization
Organization Name:WILLEM SENIOR ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HATISHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-777-8820
Mailing Address - Street 1:5820 E WT HARRIS BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3541
Mailing Address - Country:US
Mailing Address - Phone:980-224-2534
Mailing Address - Fax:
Practice Address - Street 1:8025 WILSON WOODS DR
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3534
Practice Address - Country:US
Practice Address - Phone:980-224-2534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility