Organization
GRUNDY LIFE CARE CORP
Active
Other names
Heritage Hall Grundy
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA GALLANT (COMPLIANCE & PRIVACY OFFICER)
(540) 774-4263
Entity
Organization
Contact information
Practice address
RR 5 BOX 104, GRUNDY, VA 24614-9504
(276) 935-8144
(276) 935-2316
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
NH2576
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070928800
FEDERAL BLACK LUNG ID
VA
01
—
227207
ANTHEM BCBS PPO ID
VA
05
—
4952596
—
VA
Enumeration date
10/25/2005
Last updated
11/25/2024
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