Nassawadox Life Care, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH2580 Issued in VA

Legal business name

NASSAWADOX LIFE CARE, LLC

Doing business as

Heritage Hall - Nassawadox

Practice address

9468 Hospital Rd
Nassawadox, VA 23413

Phone

(757) 442-5600

Fax

(757) 442-9401

NPI assigned

Oct 31, 2005

Last updated

Jul 6, 2018By 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

Mr. James L Haines, JD

Title

Cco & General Counsel

Phone

(540) 774-4263

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Heritage Hall - Nassawadox Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530835200000",
    "number": "1821089731",
    "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": "9468 HOSPITAL RD",
            "city": "NASSAWADOX",
            "state": "VA",
            "postal_code": "23413",
            "telephone_number": "757-442-5600",
            "fax_number": "757-442-9401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NASSAWADOX LIFE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2018-07-06",
        "status": "A",
        "authorized_official_last_name": "HAINES",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CCO & GENERAL COUNSEL",
        "authorized_official_telephone_number": "540-774-4263",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VA",
            "license": "NH2580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4952774",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS PROVIDER ID",
            "identifier": "180510",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG ID",
            "identifier": "200515605",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Hall - Nassawadox",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James Lund McDaniel, MD
• Robert Joseph Miller, CRNA
• Federico Fernando Molera, M.D.
• Christopher Joseph Mueller, DPM
• Nassawadox Life Care, LLC (Heritage Hall - Nassawadox)
• Nassawadox Rehabilitation and Nursing LLC
• Nassawadox VA Opco LLC (The Citadel Nassawadox)
• National Alternative Community Health Center, LLC
• Northampton Fire & Rescue Inc
• Northampton Radiology PC

• Skilled Nursing Facility in Nassawadox, VA
• Providers in Nassawadox, 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 Jul 6, 2018; 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.