- Enrollment id
- O20181205001485
- Enrollment state
- VA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1144211251
- Multiple npi flag
- N
- Ccn
- 495317
- Associate id
- 3678817459
- Organization name
- DILLWYN LIFE CARE, LLC
- Doing business as name
- HERITAGE HALL-DILLWYN
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- HERITAGE HALL DILLWYN
- Affiliation entity name
- HERITAGE HALL
- Affiliation entity id
- 265
- Address line 1
- 119 BRICKYARD DR
- City
- DILLWYN
- State
- VA
- Zip code
- 239363362