NPIMap

Organization Active NPI

Dillwyn Life Care, LLC

Doing business as Heritage Hall - Dillwyn

  • Skilled Nursing Facility
  • Dillwyn, VA
National Provider Identifier
1154813160
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH2574 Issued in VA
Legal business name
DILLWYN LIFE CARE, LLC
Doing business as
Heritage Hall - Dillwyn
Practice address
119 Brickyard Dr
Dillwyn, VA 23936-3362
Phone
(434) 983-2058
Fax
(434) 983-1727
NPI assigned
Jun 5, 2018
Last updated
Nov 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cassandra Gallant
Title
Compliance & Privacy Officer
Phone
(540) 774-4263

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NH2574 VA Primary

Addresses

Primary practice location

119 Brickyard Dr
Dillwyn, VA 23936-3362

Mailing address

119 Brickyard Dr
Dillwyn, VA 23936-3362
Phone (434) 983-2058

Other identifiers 3

IdentifierTypeStateIssuer
180507OtherVAANTHEM BCBS
200515609OtherFEDERAL BLACK LUNG
4953177MedicaidVA

Other names 1

  • Heritage Hall - Dillwyn Doing business as

National Provider Directory

National Provider Directory
Tax ID family
American Healthcare LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1154813160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 BRICKYARD DR",
            "city": "DILLWYN",
            "state": "VA",
            "postal_code": "239363362",
            "telephone_number": "434-983-2058",
            "fax_number": "434-983-1727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 BRICKYARD DR",
            "city": "DILLWYN",
            "state": "VA",
            "postal_code": "239363362",
            "telephone_number": "434-983-2058",
            "fax_number": "434-983-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DILLWYN LIFE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-05",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "GALLANT",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "COMPLIANCE & PRIVACY OFFICER",
        "authorized_official_telephone_number": "540-774-4263"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VA",
            "license": "NH2574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "180507",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "200515609",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4953177",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Hall - Dillwyn",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heritage Hall - Dillwyn",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dillwyn, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.