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Organization
VIRGINIA BEACH LIFE CARE CORP
Active
Organization
VIRGINIA BEACH LIFE CARE CORP
Active
Other names
Heritage Hall Virginia Beach
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES HAINES (CCO AND GENERAL COUNSEL)
(540) 774-4263
Entity
Organization
Contact information
Practice address
5580 DANIEL SMITH RD, VIRGINIA BEACH, VA 23462-1104
(757) 499-7029
(757) 499-1266
Mailing address
3131 ELECTRIC RD STE 100, ROANOKE, VA 24018-6427
(540) 774-4263
(540) 774-0780
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH2582
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
227271
ANTHEM BCBS PPO HMO ID
VA
05
—
4952341
—
VA
01
—
608693000
FEDERAL BLACK LUNG ID
VA
Enumeration date
10/26/2005
Last updated
04/01/2019
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