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Organization
NASSAWADOX LIFE CARE, LLC
Active
Organization
NASSAWADOX LIFE CARE, LLC
Active
Other names
Heritage Hall - Nassawadox
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES L HAINES JD (CCO & GENERAL COUNSEL)
(540) 774-4263
Entity
Organization
Contact information
Practice address
9468 HOSPITAL ROAD, NASSAWADOX, VA 23413-0176
(757) 442-5600
(757) 442-9401
Mailing address
PO BOX 176, NASSAWADOX, VA 23413-0176
(757) 442-5600
(757) 442-9401
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH2580
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180510
ANTHEM BCBS
—
01
—
200515605
FEDERAL BLACK LUNG
—
05
—
4952774
—
VA
Enumeration date
06/05/2018
Last updated
06/05/2018
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