# KING GEORGE LIFE CARE, LLC

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

## Provider details

- **NPI number:** 1417449422
- **Authorized official:** CASSANDRA GALLANT (COMPLIANCE & PRIVACY OFFICER)
- **Authorized official phone:** (540) 774-4263

## Contact information

- **Practice address:** 10051 FOXES WAY, KING GEORGE, VA 22485-3458
- **Practice address phone:** (540) 775-4000
- **Practice address fax:** (540) 775-3637
- **Mailing address:** 10051 FOXES WAY, KING GEORGE, VA 22485-3458
- **Mailing address phone:** (540) 775-4000
- **Mailing address fax:** (540) 775-3637

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH2577 | VA | Yes |

## Other

- **Enumeration date:** 06/05/2018
- **Last updated:** 11/25/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 180508 | ANTHEM BCBS | — |
| 01 | — | 200515607 | FEDERAL BLACK LUNG | — |
| 05 | — | 4953002 | — | VA |