NPIMap

Organization Active NPI

King George Life Care, LLC

Doing business as Heritage Hall - King George

  • Skilled Nursing Facility
  • King George, VA
National Provider Identifier
1780675702
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH2577 Issued in VA
Legal business name
KING GEORGE LIFE CARE, LLC
Doing business as
Heritage Hall - King George
Practice address
10051 Foxes Way
Box 495
King George, VA 22485
Phone
(540) 775-4000
Fax
(540) 775-3637
NPI assigned
Oct 31, 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 NH2577 VA Primary

Addresses

Primary practice location

10051 Foxes Way
Box 495
King George, VA 22485

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
200515607OtherVAFEDERAL BLACK LUNG ID
180508OtherVAANTHEM BCBS PROVIDER ID
4953002MedicaidVA

Other names 1

  • Heritage Hall - King George Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180813003253 VA Part A Provider - Skilled Nursing Facility 8628326311 Practice locations: King George, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780675702. Details of each certification follow.

Skilled nursing facility certification: CCN 495300

Legal name
KING GEORGE LIFE CARE, LLC
Doing business as
HERITAGE HALL - KING GEORGE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 1, 1995
Last certification
Sep 1, 2022
Beds
130
Ownership / control type
Limited Liability Corporation
Multi-facility organization
American Healthcare. LLC
Organization structure
LLCProprietary
Enrollment address
10051 Foxes Way
King George, VA 22485-3458
Nursing home name
HERITAGE HALL KING GEORGE
Affiliated entity
HERITAGE HALL

Care Compare: Nursing home

Medicare Care Compare
Listed as
Heritage Hall King GeorgeCCN 495300 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 1, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
13096.9 residents per day on average
Chain
Heritage Hall15 facilities in the chain
Penalties (3 years)
4Fines totaling $63,359

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.

Locations

10051 Foxes Way
#495
King George, VA 22485
Phone (540) 775-4000

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 DirectorDirector Jan 22, 2018 50%
Brad Dalton Individual Operational/Managerial Control Jul 11, 2024
Adp of the SNF Jul 11, 2024
Cassandra Gallant Individual Corporate Officer Jul 11, 2024
Operational/Managerial Control Jul 11, 2024
Adp of the SNF Jul 11, 2024
Thomas East Individual Corporate OfficerPresident Ceo Jan 22, 2018 100%
Corporate DirectorPresident Ceo Jan 22, 2018 50%
Operational/Managerial Control Apr 21, 2014
Adp of the SNF Apr 21, 2014
Shiffon Baylor Individual Operational/Managerial Control Oct 2, 2024
Adp of the SNF Oct 2, 2024
American Healthcare LLC Organization, Roanoke, VA LLC, Management services company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 22, 2018 100%
Operational/Managerial Control Jan 22, 2018
Adp of the SNF Jan 22, 2018
Robert Dalton Individual Corporate OfficerCfo Jan 22, 2018
Operational/Managerial Control Jul 11, 2024
Adp of the SNF Jul 11, 2024
Petros Ayele Individual Operational/Managerial Control Oct 2, 2024
Adp of the SNF Oct 2, 2024

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 1

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": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1780675702",
    "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": "10051 FOXES WAY",
            "address_2": "BOX 495",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "22485",
            "telephone_number": "540-775-4000",
            "fax_number": "540-775-3637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING GEORGE LIFE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "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": "NH2577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG ID",
            "identifier": "200515607",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS PROVIDER ID",
            "identifier": "180508",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4953002",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Hall - King George",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in King George, VA

Sources for this page

Verify at the official NPI Registry.