Blackstone Life Care, LLC
Organization Active NPI Skilled Nursing Facility · Blackstone, VA
NPI 1326038720 · NPPES record last updated Nov 25, 2024
Key facts
- NPI
- 1326038720
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- NH2570 (VA)
- Legal business name
- BLACKSTONE LIFE CARE, LLC
- Practice address
- 900 S Main St
Blackstone, VA 23824 - Phone
- (434) 292-5301
- Fax
- (434) 292-6041
- NPI assigned
- Oct 26, 2005
- Organization subpart
- No
Authorized official
- Name
- Cassandra Gallant
- Title
- Compliance & Privacy Officer
- Phone
- (540) 774-4263
Owners & managing parties with NPI records 1
-
Mazen I Madhoun, MD
Corporate family (same tax ID) 1
Facilities with the same owner 14
Affiliated clinicians 2
-
Mazen I Madhoun, MD
Medicare Care Compare: Nursing home
- Listed as
- Heritage Hall-Blackstone
- 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
- Active
- Certified beds
- 180 · 132.6 residents per day on average
- Chain
- Heritage Hall
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
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
- LLC · Proprietary
- 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
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| William B Hopkins |
Corporate Director | Jul 23, 2010 | |
| Brad Dalton |
Corporate Officer | Apr 21, 2014 | |
| Operational/Managerial Control | Apr 21, 2014 | ||
| Mazen I Madhoun |
Adp of the SNF | Oct 2, 2018 | |
| Cassandra Gallant |
Corporate Officer | Jul 11, 2024 | |
| Adp of the SNF | Jul 11, 2024 | ||
| Thomas East |
Corporate Officer |
Nov 20, 2012 | |
| Corporate Director |
Nov 20, 2012 | ||
| Adp of the SNF | Apr 21, 2014 | ||
| Gregory Ashley |
Operational/Managerial Control | Apr 1, 2024 | |
| Adp of the SNF | Apr 1, 2024 | ||
| American Healthcare LLC |
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 |
Corporate Officer | Apr 21, 2014 | |
| Operational/Managerial Control | Apr 21, 2014 | ||
| Adp of the SNF | Apr 21, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180809004067 | VA | Part a Provider - Skilled Nursing Facility | 5799033601 | Practice locations: Blackstone, VA |
National Provider Directory
- Tax ID family
- American Healthcare LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NH2570 | VA | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 180505 | Other | VA | ANTHEM BCBS PROVIDER ID |
| 4953533 | Medicaid | VA | |
| 200515603 | Other | VA | FEDERAL BLACK LUNG ID |
Other names
- Heritage Hall - Blackstone
Other providers in Blackstone, VA
- Sandra Allmond Bagley
- Curtis Grant Barnes
- Bennett Logistics, LLC
- Blackstone Counseling & Behavioral Health, LLC
- Blackstone Life Care, LLC
- Blackstone Physical Therapy LLC
- Blackstone Vol.Fire Dept
- Bon Secours St. Francis Medical Center, Inc.
- Bon Secours St. Francis Medical Center, Inc.
- Bon Secours-Virginia Healthsource
All providers in Blackstone, VA · Skilled Nursing Facility in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.