NPIMap

Organization Active NPI

Rich Creek Life Care, LLC

Doing business as Heritage Hall - Rich Creek

  • Skilled Nursing Facility
  • Rich Creek, VA
National Provider Identifier
1780688747
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH2673 Issued in VA
Legal business name
RICH CREEK LIFE CARE, LLC
Doing business as
Heritage Hall - Rich Creek
Practice address
120 Old Virginia Ave
Rich Creek, VA 24147-9669
Phone
(540) 726-2328
Fax
(540) 726-2519
NPI assigned
Jun 8, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X NH2673 VA
Skilled Nursing Facility 314000000X NH2673 VA Primary

Addresses

Primary practice location

120 Old Virginia Ave
Rich Creek, VA 24147-9669

Mailing address

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

Other names 1

  • Heritage Hall - Rich Creek Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230504002915 VA Part A Provider - Skilled Nursing Facility 1153786686 Practice locations: Rich Creek, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780688747. Details of each certification follow.

Skilled nursing facility certification: CCN 495371

Legal name
RICH CREEK LIFE CARE, LLC.
Doing business as
HERITAGE HALL -RICH CREEK
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 2003
Last certification
Mar 14, 2024
Beds
120
Ownership / control type
Limited Liability Corporation
Multi-facility organization
American Healthcare
Most recent change of ownership
Dec 30, 2013
Organization structure
LLCProprietary
Incorporated
Jun 17, 2023 in VA
Enrollment address
120 Old Virginia Ave
Rich Creek, VA 24147-9669
Nursing home name
HERITAGE HALL-RICH CREEK
Affiliated entity
HERITAGE HALL

Care Compare: Nursing home

Medicare Care Compare
Listed as
Heritage Hall-Rich CreekCCN 495371 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 1, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120101.5 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

Ownership & related parties

All disclosed owners & managing parties 7

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 Dec 30, 2013 100%
Sharon Lambert-McDaniel Individual Operational/Managerial Control Jun 6, 2025
Adp of the SNF Jun 6, 2025
Mazen I Madhoun Individual Adp of the SNF Jun 6, 2025
Cassandra Gallant Individual Corporate Officer Jul 11, 2024
Adp of the SNF Jul 11, 2024
Thomas East Individual Corporate OfficerPresident and Ceo Dec 30, 2013 100%
Adp of the SNF Apr 21, 2014
American Healthcare LLC Organization, Roanoke, VA LLC, Management services company, For-profit, Chain home office, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 17, 2022 100%
Operational/Managerial Control Dec 3, 2024
Adp of the SNF Dec 5, 2024
Robert Dalton Individual Corporate OfficerChief Financial Officer Dec 30, 2013 75%
Operational/Managerial Control Dec 30, 2013
Adp of the SNF Dec 30, 2013

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1118188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1780688747",
    "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": "120 OLD VIRGINIA AVE",
            "city": "RICH CREEK",
            "state": "VA",
            "postal_code": "241479669",
            "telephone_number": "540-726-2328",
            "fax_number": "540-726-2519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICH CREEK LIFE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-08",
        "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": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "VA",
            "license": "NH2673",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VA",
            "license": "NH2673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Hall - Rich Creek",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heritage Hall - Rich Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rich Creek, VA

Sources for this page

Verify at the official NPI Registry.