Organization
BLACKSTONE LIFE CARE, LLC
Active
Other names
Heritage Hall - Blackstone
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA GALLANT (COMPLIANCE & PRIVACY OFFICER)
(540) 774-4263
Entity
Organization
Contact information
Practice address
900 S MAIN ST, BLACKSTONE, VA 23824
(434) 292-5301
(434) 292-6041
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
NH2570
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180505
ANTHEM BCBS PROVIDER ID
VA
01
—
200515603
FEDERAL BLACK LUNG ID
VA
05
—
4953533
—
VA
Enumeration date
10/26/2005
Last updated
11/25/2024
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