Provider Demographics
NPI:1932601747
Name:LAKE PRINCE AT HOME LLC
Entity Type:Organization
Organization Name:LAKE PRINCE AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R 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 LEONARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-9649
Mailing Address - Country:US
Mailing Address - Phone:828-465-8021
Mailing Address - Fax:828-465-8015
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE PRINCE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-07
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health