LEESBURG LIFE CARE, LLC (NPI# 1578553970) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578553970 |
| Entity Type | Organization |
| Organization Name | LEESBURG LIFE CARE, LLC |
| Other Organization Name | HERITAGE HALL - LEESBURG |
| Practice Address |
122 Morven Park Rd Nw Leesburg VA 20176 |
| Mailing Address |
3131 Electric Rd Roanoke VA 24018-6427 |
| Practice Telephone | 7037778700 |
| Practice Fax Number | 7037771532 |
| Mailing Telephone | 5407744263 |
| Mailing Fax Number | 5407740780 |
| Enumeration Date | 2005-10-26 |
| 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 | NH2584 | VA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | FEDERAL BLACK LUNG ID | 200515604 | 01 |
| VA | 4952618 | 05 | |
| VA | ANTHEM BCBS PROVIDER ID | 180509 | 01 |
| Other Name | Type Code |
|---|---|
| Heritage Hall - Leesburg | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548752629 | Leesburg Life Care, LLC | Skilled Nursing Facility | 122 Morven Park Rd Nw, Leesburg, VA 20176-2024 | 2018-06-04 |
| Street Address |
122 MORVEN PARK RD NW |
| City | LEESBURG |
| State | VA |
| Zip Code | 20176 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548752629 | Leesburg Life Care, LLC | Skilled Nursing Facility | 122 Morven Park Rd Nw, Leesburg, VA 20176-2024 | 2018-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053912923 | Timothy Michael Nixon | Pharmacist | 61 Catoctin Circle, Leesburg, VA 20176 | 2020-11-05 |
| 1558996645 | Stacey E Moran | Occupational Therapist | 44124 Woodrige Parkway, Lansdowne, VA 20176 | 2020-03-09 |
| 1710531272 | Joseph H Kasuska Jr. | Specialist/Technologist | 19455 Deerfield Ave. Suite 306, Lansdowne, VA 20176 | 2019-08-01 |
| 1568935849 | Joel Manalang Polintan Jr. | Physical Therapist | 171 Cedarwalk Circle, Leesburg, VA 20176 | 2019-01-09 |
| 1194203026 | Jing Cao | Acupuncturist | 19450 Deerfield Ave Ste 275, Leesburg, VA 20176 | 2018-08-02 |
| 1134648314 | Alaina Marie Gotwalt | Speech-Language Pathologist | 43850 Heatherstone Terrace, Unit 406, Leesburg, VA 20176 | 2017-09-19 |
| 1841717105 | Happy Inhome Care Corp | Respite Care | 722 E Market St Ste 103, Leesburg, VA 20176 | 2017-08-28 |
| 1912423484 | Aaa Good Healthcare LLC | Nursing Care | 722 East Market Street Ne, Suite 102, Leesburg, VA 20176 | 2017-08-16 |
| 1740704253 | Anna Maria Domingo Seaford | Physician Assistant | 19441 Golf Vista Plz Ste 230, Lansdowne, VA 20176 | 2017-07-27 |
| 1710436480 | Reena Patel | Physician Assistant | 224 Cornwall St Nw Leesburg Orthope, Unit 204, Leesburg, VA 20176 | 2016-09-23 |
| Find all providers in zip 20176 | ||||
| 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 |
|---|---|---|---|---|
| 1538223722 | Avante At Leesburg, Inc. | Skilled Nursing Facility | 2000 Edgewood Ave, Leesburg, FL 34748-5516 | 2006-12-21 |
| 1740295476 | Lake Harris Health Systems LLC | Skilled Nursing Facility | 701 Lake Port Blvd, Leesburg, FL 34748-7674 | 2006-07-30 |
| 1194746032 | Loudoun Nursing and Rehabiliation Center | Skilled Nursing Facility | 235 Old Waterford Rd Nw, Leesburg, VA 20176-2117 | 2006-07-23 |
| 1750370656 | Leesburg Health and Rehab | Skilled Nursing Facility | 715 E Dixie Ave, Leesburg, FL 34748-5926 | 2005-10-14 |
| 1548752629 | Leesburg Life Care, LLC | Skilled Nursing Facility | 122 Morven Park Rd Nw, Leesburg, VA 20176-2024 | 2018-06-04 |
| 1629455779 | South Campus Facility Inc | Skilled Nursing Facility | 715 E Dixie Ave, Leesburg, FL 34748-5926 | 2015-04-28 |
| 1073927331 | Ccrc - Lake Port Square, LLC | Skilled Nursing Facility | 701 Lake Port Blvd, Leesburg, FL 34748-7674 | 2014-06-16 |
| 1326479452 | Ncrnc Inc. | Skilled Nursing Facility | 700 N Palmetto St, Leesburg, FL 34748-4419 | 2013-11-27 |
| 1073866166 | Dixie Highway Snf LLC | Skilled Nursing Facility | 715 E Dixie Ave, Leesburg, FL 34748-5926 | 2012-10-26 |
| 1083876312 | Laraine Catherine Astarita | Skilled Nursing Facility | 700 N Palmetto St, Leesburg, FL 34748-4419 | 2008-06-27 |
| Find all providers in LEESBURG | ||||
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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.