Organization
VIRGINIA BEACH LIFE CARE CORP
Active
Other names
Heritage Hall Virginia Beach
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES HAINES (CCO AND GENERAL COUNSEL)
(540) 774-4263
Entity
Organization
Contact information
Practice address
5580 DANIEL SMITH RD, VIRGINIA BEACH, VA 23462-1104
(757) 499-7029
(757) 499-1266
Mailing address
3131 ELECTRIC RD STE 100, ROANOKE, VA 24018-6427
(540) 774-4263
(540) 774-0780
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH2582
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
227271
ANTHEM BCBS PPO HMO ID
VA
05
—
4952341
—
VA
01
—
608693000
FEDERAL BLACK LUNG ID
VA
Enumeration date
10/26/2005
Last updated
04/01/2019
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