# NASSAWADOX LIFE CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Heritage Hall - Nassawadox
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821089731
- **Authorized official:** MR. JAMES L HAINES JD (CCO & GENERAL COUNSEL)
- **Authorized official phone:** (540) 774-4263

## Contact information

- **Practice address:** 9468 HOSPITAL RD, NASSAWADOX, VA 23413
- **Practice address phone:** (757) 442-5600
- **Practice address fax:** (757) 442-9401
- **Mailing address:** 3131 ELECTRIC RD, ROANOKE, VA 24018-6427
- **Mailing address phone:** (540) 774-4263
- **Mailing address fax:** (540) 774-0780

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH2580 | VA | Yes |

## Other

- **Enumeration date:** 10/31/2005
- **Last updated:** 07/06/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 180510 | ANTHEM BCBS PROVIDER ID | VA |
| 01 | — | 200515605 | FEDERAL BLACK LUNG ID | VA |
| 05 | — | 4952774 | — | VA |