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Organization
BIG STONE GAP LIFE CARE, LLC
Active
Organization
BIG STONE GAP LIFE CARE, LLC
Active
Other names
Heritage Hall - Big Stone Gap
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA GALLANT (COMPLIANCE & PRIVACY OFFICER)
(540) 774-4263
Entity
Organization
Contact information
Practice address
2045 VALLEY VIEW DR, BIG STONE GAP, VA 24219-3319
(276) 523-3000
(276) 523-0531
Mailing address
2045 VALLEY VIEW DR, BIG STONE GAP, VA 24219-3319
(276) 523-3000
(276) 523-0531
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH2568
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180506
ANTHEM BCBS
—
01
—
200515602
FEDERAL BLACK LUNG
—
05
—
4951352
—
VA
Enumeration date
06/05/2018
Last updated
11/25/2024
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