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Organization
CLINTWOOD LIFE CARE, LLC
Active
Organization
CLINTWOOD LIFE CARE, LLC
Active
Other names
Heritage Hall - Clintwood
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA GALLANT (COMPLIANCE & PRIVACY OFFICER)
(540) 774-4263
Entity
Organization
Contact information
Practice address
1225 CLINTWOOD MAIN ST, CLINTWOOD, VA 24228
(276) 926-4693
(276) 926-9128
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
NH2573
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
177351
ANTHEM BCBS PROVIDER ID
VA
01
—
200515606
FEDERAL BLACK LUNG ID
VA
05
—
4953207
—
VA
Enumeration date
10/31/2005
Last updated
11/25/2024
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