# BROOKNEAL LIFE CARE CORP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Heritage Hall Brookneal
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295725455
- **Authorized official:** CASSANDRA GALLANT (COMPLIANCE & PRIVACY OFFICER)
- **Authorized official phone:** (540) 774-4263

## Contact information

- **Practice address:** 633 COOK AVE, BROOKNEAL, VA 24528-1470
- **Practice address phone:** (434) 376-3740
- **Practice address fax:** (434) 376-3776
- **Mailing address:** 3131 ELECTRIC RD, ROANOKE, VA 24018-6427
- **Mailing address phone:** (540) 774-4263
- **Mailing address fax:** (540) 774-0780

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH2571 | VA | Yes |

## Other

- **Enumeration date:** 10/27/2005
- **Last updated:** 11/25/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 227237 | ANTHEM BCBS HMO PPO ID | VA |
| 05 | — | 4952421 | — | VA |
| 01 | — | 608695300 | FEDERAL BLACK LUNG ID | VA |