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Organization
BLACKSBURG LIFE CARE, LLC
Active
Organization
BLACKSBURG LIFE CARE, LLC
Active
Other names
Heritage Hall - Blacksburg
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA GALLANT (COMPLIANCE & PRIVACY OFFICER)
(540) 774-4263
Entity
Organization
Contact information
Practice address
3610 S MAIN ST, BLACKSBURG, VA 24060
(540) 951-7000
(540) 951-4109
Mailing address
3131 ELECTRIC RD, ROANOKE, VA 24018-6427
(540) 774-4263
(540) 774-0780
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH2569
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180503
ANTHEM BCBS PROVIDER ID
VA
01
—
200515600
FEDERAL BLACK LUNG
VA
05
—
4953568
—
VA
Enumeration date
10/26/2005
Last updated
05/08/2026
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