Provider Demographics
NPI:1073500310
Name:LAKE PRINCE CENTER, INC.
Entity Type:Organization
Organization Name:LAKE PRINCE CENTER, INC.
Other - Org Name:LAKE PRINCE WOODS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:SUTTON
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-465-8021
Mailing Address - Street 1:100 ANNA GOODE WAY
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-9236
Mailing Address - Country:US
Mailing Address - Phone:757-923-5500
Mailing Address - Fax:757-923-5502
Practice Address - Street 1:100 ANNA GOODE WAY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-9236
Practice Address - Country:US
Practice Address - Phone:757-923-5500
Practice Address - Fax:757-923-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2752314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA495366Medicare ID - Type UnspecifiedMEDICARE