NPIMap

Organization Active NPI

Blackstone Life Care, LLC

Doing business as Heritage Hall - Blackstone

  • Skilled Nursing Facility
  • Blackstone, VA
National Provider Identifier
1326038720
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH2570 Issued in VA
Legal business name
BLACKSTONE LIFE CARE, LLC
Doing business as
Heritage Hall - Blackstone
Practice address
900 S Main St
Blackstone, VA 23824
Phone
(434) 292-5301
Fax
(434) 292-6041
NPI assigned
Oct 26, 2005
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 NH2570 VA Primary

Addresses

Primary practice location

900 S Main St
Blackstone, VA 23824

Mailing address

3131 Electric Rd
Roanoke, VA 24018-6427
Phone (540) 774-4263

Other identifiers 3

IdentifierTypeStateIssuer
180505OtherVAANTHEM BCBS PROVIDER ID
200515603OtherVAFEDERAL BLACK LUNG ID
4953533MedicaidVA

Other names 1

  • Heritage Hall - Blackstone Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180809004067 VA Part A Provider - Skilled Nursing Facility 5799033601 Practice locations: Blackstone, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326038720. Details of each certification follow.

Skilled nursing facility certification: CCN 495353

Legal name
BLACKSTONE LIFE CARE, LLC
Doing business as
HERITAGE HALL- BLACKSTONE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 1, 2001
Last certification
May 17, 2023
Beds
180
Ownership / control type
Limited Liability Corporation
Multi-facility organization
American Healthcare LLC
Organization structure
LLCProprietary
Incorporated
Jan 22, 2018 in VA
Enrollment address
900 S Main St
Blackstone, VA 23824-2644
Nursing home name
HERITAGE HALL-BLACKSTONE
Affiliated entity
HERITAGE HALL

Care Compare: Nursing home

Medicare Care Compare
Listed as
Heritage Hall-BlackstoneCCN 495353 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 1, 2001
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
180132.6 residents per day on average
Chain
Heritage Hall15 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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.

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
William B Hopkins Individual Corporate Director Jul 23, 2010
Brad Dalton Individual Corporate Officer Apr 21, 2014
Operational/Managerial Control Apr 21, 2014
Mazen I Madhoun Individual Adp of the SNF Oct 2, 2018
Cassandra Gallant Individual Corporate Officer Jul 11, 2024
Adp of the SNF Jul 11, 2024
Thomas East Individual Corporate OfficerPresident, Ceo Nov 20, 2012
Corporate DirectorPresident, Ceo Nov 20, 2012
Adp of the SNF Apr 21, 2014
Gregory Ashley Individual Operational/Managerial Control Apr 1, 2024
Adp of the SNF Apr 1, 2024
American Healthcare LLC Organization, Roanoke, VA LLC, Chain home office 5% Or Greater Direct Ownership Interest Jan 22, 2018 100%
Operational/Managerial Control Jan 22, 2018
Adp of the SNF May 13, 2025
Robert Dalton Individual Corporate Officer Apr 21, 2014
Operational/Managerial Control Apr 21, 2014
Adp of the SNF Apr 21, 2014

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 14

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 14

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1326038720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 ELECTRIC RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240186427",
            "telephone_number": "540-774-4263",
            "fax_number": "540-774-0780"
        },
        {
            "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": "23824",
            "telephone_number": "434-292-5301",
            "fax_number": "434-292-6041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKSTONE LIFE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "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": "NH2570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS PROVIDER ID",
            "identifier": "180505",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG ID",
            "identifier": "200515603",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4953533",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Hall - Blackstone",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blackstone, VA

Sources for this page

Verify at the official NPI Registry.