Leesburg Life Care, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LEESBURG LIFE CARE, LLC

Practice address

122 Morven Park Rd NW
Leesburg, VA 20176-2024

Phone

(703) 777-8700

Fax

(703) 777-1532

NPI assigned

Jun 4, 2018

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 - Leesburg 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.

• Leesburg Life Care, LLC

  • Skilled Nursing Facility
  • Leesburg, VA
  • NPI 1578553970
  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": "1548752629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 MORVEN PARK RD NW",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201762024",
            "telephone_number": "703-777-8700",
            "fax_number": "703-777-1532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 MORVEN PARK RD NW",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201762024",
            "telephone_number": "703-777-8700",
            "fax_number": "703-777-1532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEESBURG 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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "200515604",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4952618",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "180509",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Hall - Leesburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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