- Enrollment id
- O20060203000449
- Enrollment state
- VA
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1912997594
- Multiple npi flag
- N
- Ccn
- 495259
- Associate id
- 4587685243
- Organization name
- GRUNDY LIFE CARE CORP
- Doing business as name
- GRUNDY LIFE CARE CORP. D/B/A HERITAGE HALL-GRUNDY
- Incorporation date
- 1998-07-01
- Incorporation state
- VA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- HERITAGE HALL GRUNDY
- Affiliation entity name
- HERITAGE HALL
- Affiliation entity id
- 265
- Address line 1
- 2966 SLATE CREEK ROAD
- City
- GRUNDY
- State
- VA
- Zip code
- 246146969