Clintwood Life Care, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH2573 Issued in VA

Legal business name

CLINTWOOD LIFE CARE, LLC

Doing business as

Heritage Hall - Clintwood

Practice address

1225 Clintwood Main St
Clintwood, VA 24228-7221

Phone

(276) 926-4693

Fax

(276) 926-9128

NPI assigned

Jun 5, 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 - Clintwood 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.

• Clintwood Life Care, LLC

  dba Heritage Hall - Clintwood

  • Skilled Nursing Facility
  • Clintwood, VA
  • NPI 1447241351
  NPD tax ID

Locations

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": "1437641446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 CLINTWOOD MAIN ST",
            "city": "CLINTWOOD",
            "state": "VA",
            "postal_code": "242287221",
            "telephone_number": "276-926-4693",
            "fax_number": "276-926-9128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 CLINTWOOD MAIN ST",
            "city": "CLINTWOOD",
            "state": "VA",
            "postal_code": "242287221",
            "telephone_number": "276-926-4693",
            "fax_number": "276-926-9128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINTWOOD 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": "NH2573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "177351",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4953207",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "200515606",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Hall - Clintwood",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heritage Hall - Clintwood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brandon R Bise, LPC
• Heather Dawn Blair, FNP
• Tammy Ann Branham, FNP
• Charles M Owens OD PC
• Shelda Cline, MPT
• Clintwood Life Care, LLC (Heritage Hall - Clintwood)
• Clintwood Volunteer Rescue Squad Inc
• Blakelee Suzanne Coleman, PHARMD
• Gene Henry Collins, ED.S. NCSP
• Lindsay Sutherland Compton, M.S. CCC-SLP

• Skilled Nursing Facility in Clintwood, VA
• Providers in Clintwood, 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.