49D0707456 CLIA NUMBER - LEESBURG LIFE CARE LLC DBA HERITAGE HALL - LEESBURG

Laboratory Demographics

  • CLIA Code: 49D0707456
  • Facility Name: LEESBURG LIFE CARE LLC DBA HERITAGE HALL - LEESBURG
  • Facility Address: 122 MORVEN PARK RD NW
    LEESBURG, VA
    ZIP 20176
  • Facility Phone: 703 777-8700
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JEREMY L. NETTIN
  • NPI Number: 1548752629
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 49D0707456
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name LEESBURG LIFE CARE LLC DBA HERITAGE HALL - LEESBURG
Street 122 MORVEN PARK RD NW
City LEESBURG
State VA
ZIP 20176
Phone 703 777-8700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JEREMY L. NETTIN

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This page was last updated on: 9/29/2025