Organization
CLINTWOOD LIFE CARE, LLC
Active
Other names
Heritage Hall - Clintwood
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA GALLANT (COMPLIANCE & PRIVACY OFFICER)
(540) 774-4263
Entity
Organization
Contact information
Practice address
1225 CLINTWOOD MAIN ST, CLINTWOOD, VA 24228-7221
(276) 926-4693
(276) 926-9128
Mailing address
1225 CLINTWOOD MAIN ST, CLINTWOOD, VA 24228-7221
(276) 926-4693
(276) 926-9128
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH2573
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
177351
ANTHEM BCBS
—
01
—
200515606
FEDERAL BLACK LUNG
—
05
—
4953207
—
VA
Enumeration date
06/05/2018
Last updated
11/25/2024
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