- Enrollment id
- O20180810002957
- Enrollment state
- VA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1679563068
- Multiple npi flag
- N
- Ccn
- 495135
- Associate id
- 1850649567
- Organization name
- BIG STONE GAP LIFE CARE LLC
- Doing business as name
- HERITAGE HALL- BIG STONE GAP
- Incorporation state
- VA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- HERITAGE HALL BIG STONE GAP
- Affiliation entity name
- HERITAGE HALL
- Affiliation entity id
- 265
- Address line 1
- 2045 VALLEY VIEW DR
- City
- BIG STONE GAP
- State
- VA
- Zip code
- 242193319