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Organization
NASSAWADOX LIFE CARE, LLC
Active
Organization
NASSAWADOX LIFE CARE, LLC
Active
Other names
Heritage Hall - Nassawadox
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES L HAINES JD (CCO & GENERAL COUNSEL)
(540) 774-4263
Entity
Organization
Contact information
Practice address
9468 HOSPITAL RD, NASSAWADOX, VA 23413
(757) 442-5600
(757) 442-9401
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
NH2580
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180510
ANTHEM BCBS PROVIDER ID
VA
01
—
200515605
FEDERAL BLACK LUNG ID
VA
05
—
4952774
—
VA
Enumeration date
10/31/2005
Last updated
07/06/2018
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