MEDICARE: BROOKNEAL LIFE CARE CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	NH2571	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	227237	OTHER	VA	ANTHEM BCBS HMO PPO ID
3	608695300	OTHER	VA	FEDERAL BLACK LUNG ID

General Provider Information

NPI Number	:	1295725455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKNEAL LIFE CARE CORP

Provider Business Mailing Address
First Line	:	3131 ELECTRIC RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-6427
Country	:	US
Telephone Number	:	540-774-4263
Fax Number	:	540-774-0780

Provider Business Practice Location Address
First Line	:	633 COOK AVE
Second Line	:
City	:	BROOKNEAL
State	:	VA
Zip	:	24528-1470
Country	:	US
Telephone Number	:	434-376-3740
Fax Number	:	434-376-3776

Authorized Official
Title or Position	:	COMPLIANCE & PRIVACY OFFICER
Name	:	CASSANDRA GALLANT
Credential	:
Telephone Number	:	540-774-4263

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	11/25/2024

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Directions to “BROOKNEAL LIFE CARE CORP ” Practice Location

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