Active NPI
Tazewell Life Care, LLC
Doing business as Heritage Hall - Tazewell
- Skilled Nursing Facility
- Tazewell, VA
National Provider Identifier
1154813228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- NH2581
- Legal business name
- TAZEWELL LIFE CARE, LLC
- Doing business as
- Heritage Hall - Tazewell
- Practice address
- 282 Ben Bolt Ave
Tazewell, VA 24651-5384 - Phone
- (276) 988-2515
- Fax
- (276) 988-5468
- NPI assigned
- Jun 4, 2018
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NH2581 | Primary |
Addresses
Primary practice location
282 Ben Bolt Ave
Tazewell, VA 24651-5384
Mailing address
282 Ben Bolt Ave
Tazewell, VA 24651-5384
Phone (276) 988-2515
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 180511 | Other | ANTHEM BCBS | |
| 200515601 | Other | FEDERAL BLACK LUNG | |
| 418359 | Other | COMBINED INS CO OF AMERICA | |
| 4951522 | Medicaid | VA |
Other names 1
- Heritage Hall - Tazewell
National Provider Directory
National Provider Directory- Tax ID family
- American Healthcare LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Heritage Hall - Tazewell
- Skilled Nursing Facility
- Tazewell, VA
- NPI 1538159926
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528070400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1732492800000",
"number": "1154813228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "282 BEN BOLT AVE",
"city": "TAZEWELL",
"state": "VA",
"postal_code": "246515384",
"telephone_number": "276-988-2515",
"fax_number": "276-988-5468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "282 BEN BOLT AVE",
"city": "TAZEWELL",
"state": "VA",
"postal_code": "246515384",
"telephone_number": "276-988-2515",
"fax_number": "276-988-5468"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TAZEWELL LIFE CARE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-06-04",
"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": null,
"license": "NH2581",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "180511",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL BLACK LUNG",
"identifier": "200515601",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMBINED INS CO OF AMERICA",
"identifier": "418359",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4951522",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Heritage Hall - Tazewell",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tazewell, 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.