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Organization
KING GEORGE LIFE CARE, LLC
Active
Organization
KING GEORGE LIFE CARE, LLC
Active
Other names
Heritage Hall - King George
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA GALLANT (COMPLIANCE & PRIVACY OFFICER)
(540) 774-4263
Entity
Organization
Contact information
Practice address
10051 FOXES WAY, BOX 495, KING GEORGE, VA 22485
(540) 775-4000
(540) 775-3637
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
NH2577
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180508
ANTHEM BCBS PROVIDER ID
VA
01
—
200515607
FEDERAL BLACK LUNG ID
VA
05
—
4953002
—
VA
Enumeration date
10/31/2005
Last updated
11/25/2024
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