KING GEORGE LIFE CARE, LLC (NPI# 1780675702) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780675702 |
| Entity Type | Organization |
| Organization Name | KING GEORGE LIFE CARE, LLC |
| Other Organization Name | HERITAGE HALL - KING GEORGE |
| Practice Address |
10051 Foxes Way Box 495 King George VA 22485 |
| Mailing Address |
3131 Electric Rd Roanoke VA 24018-6427 |
| Practice Telephone | 5407754000 |
| Practice Fax Number | 5407753637 |
| Mailing Telephone | 5407744263 |
| Mailing Fax Number | 5407740780 |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2018-07-06 |
| Authorized Official Name | MR. JAMES L HAINES (CCO & GENERAL COUNSEL) |
| Authorized Official Telephone | 5407744263 |
| Authorized Official Credential | JD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | NH2577 | VA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | ANTHEM BCBS PROVIDER ID | 180508 | 01 |
| VA | 4953002 | 05 | |
| VA | FEDERAL BLACK LUNG ID | 200515607 | 01 |
| Other Name | Type Code |
|---|---|
| Heritage Hall - King George | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417449422 | King George Life Care, LLC | Skilled Nursing Facility | 10051 Foxes Way, King George, VA 22485-3458 | 2018-06-05 |
| Street Address |
10051 FOXES WAY BOX 495 |
| City | KING GEORGE |
| State | VA |
| Zip Code | 22485 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417449422 | King George Life Care, LLC | Skilled Nursing Facility | 10051 Foxes Way, King George, VA 22485-3458 | 2018-06-05 |
| 1952795718 | Pauline Wills | Speech-Language Pathologist | 10051 Foxes Way, King George, VA 22485-3458 | 2015-03-19 |
| 1851707228 | Stephanie Linda Dove | Speech-Language Pathologist | 10051 Foxes Way, King George, VA 22485-3458 | 2014-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528699675 | Philicia J King | Nurse Practitioner | 16463 Va-206, King George, VA 22485 | 2020-01-28 |
| 1811492994 | Jason J Wheeler | Psychologist | King George High School, 10100 Foxes Way, King George, VA 22485 | 2018-03-29 |
| 1649668690 | Access Eye Centers, PC | Optometrist | 7961 Kings Hwy., King George, VA 22485 | 2014-12-29 |
| 1568808277 | Alice Ann Pallotti | Massage Therapist | 9305 King's Hwy, Suite A, King George, VA 22485 | 2013-05-21 |
| 1679876296 | Virginia Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 11458 Kings Highway, King George, VA 22485 | 2010-12-21 |
| 1962679506 | Kathleen Ann Fitzsimmons | Counselor | 5506 Payne Dr, King George, VA 22485 | 2008-05-13 |
| 1275574279 | Kristie F Mcdowell | Physician Assistant | 11131 Journal Parkway, King George, VA 22485 | 2006-06-09 |
| 1881059624 | Jill Bain Wine | Speech-Language Pathologist | 5254 Potomac Dr Ste A, King George, VA 22485 | 2015-12-21 |
| 1245486802 | Roosevelt Dean Jr. | Family Medicine | 11131 Journal Parkway, King George, VA 22485 | 2008-08-14 |
| 1619080611 | Michael Joseph Costa | Family Medicine | 11131 Journal Parkway, King George, VA 22485 | 2006-08-16 |
| Find all providers in zip 22485 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417449422 | King George Life Care, LLC | Skilled Nursing Facility | 10051 Foxes Way, King George, VA 22485-3458 | 2018-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760015119 | Mikaylah Lang | Skilled Nursing Facility | 4505 Georgewashington Hwy, Portsmouth, VA 23702 | 2020-02-13 |
| 1134760432 | Valley Operator LLC | Skilled Nursing Facility | 940 E Lee Hwy, Chilhowie, VA 24319-3237 | 2019-10-08 |
| 1871134171 | Westport Operator LLC | Skilled Nursing Facility | 7300 Forest Ave, Richmond, VA 23226-3735 | 2019-10-08 |
| 1437790730 | Hopewell Operator LLC | Skilled Nursing Facility | 905 Cousins Ave, Hopewell, VA 23860-6507 | 2019-10-08 |
| 1013478411 | Blue Ridge Snf Operations LLC | Skilled Nursing Facility | 105 Landmark Dr, Stuart, VA 24171-9401 | 2019-03-28 |
| 1265924260 | Nassawadox Life Care, LLC | Skilled Nursing Facility | 9468 Hospital Road, Nassawadox, VA 23413-0176 | 2018-06-05 |
| 1518459593 | Big Stone Gap Life Care, LLC | Skilled Nursing Facility | 2045 Valley View Dr, Big Stone Gap, VA 24219-3319 | 2018-06-05 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1538600036 | Prince William H&r Ops Limited Partnership | Skilled Nursing Facility | 14935 Holly Knoll Lane, Gainesville, VA 20155 | 2017-03-16 |
| 1033660360 | Nathan Ian Dalleave | Skilled Nursing Facility | 1243 Lanier Rd, Martinsville, VA 24112-5211 | 2016-10-21 |
| Find all providers with the same taxonomy | ||||
| City | KING GEORGE |
| Zip Code | 22485 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.