Blackstone Life Care, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BLACKSTONE LIFE CARE, LLC

Doing business as

Heritage Hall - Blackstone

Practice address

900 S Main St
Blackstone, VA 23824-2644

Phone

(434) 292-5301

Fax

(434) 292-6041

NPI assigned

Jun 4, 2018

Last updated

Nov 25, 2024By the provider in NPPES

Organization subpart

No

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

Addresses

Other identifiers 3

Other names 1

• Heritage Hall - Blackstone Doing business as

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.

• Blackstone Life Care, LLC

  dba Heritage Hall - Blackstone

  • Skilled Nursing Facility
  • Blackstone, VA
  • NPI 1326038720
  NPD tax ID

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": "1215429386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S MAIN ST",
            "city": "BLACKSTONE",
            "state": "VA",
            "postal_code": "238242644",
            "telephone_number": "434-292-5301",
            "fax_number": "434-292-6041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 S MAIN ST",
            "city": "BLACKSTONE",
            "state": "VA",
            "postal_code": "238242644",
            "telephone_number": "434-292-5301",
            "fax_number": "434-292-6041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKSTONE 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": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4953533",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "180505",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "200515603",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Hall - Blackstone",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Blackstone, VA
• Providers in Blackstone, VA by specialty
• Skilled Nursing Facility in Virginia

• 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.