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General NPI Number Information
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NPI Number | 1174112445
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Entity Type | Organization
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Legal Business Name | LAKE PRINCE AT HOME LLC
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 100 ANNA GOODE WAY
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City | SUFFOLK
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State | VA
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Zip | 23434-9236
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Country | US
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Telephone | 757-923-5559
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Fax | 757-257-0421
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Provider Business Mailing Address
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Address Line | 100 ANNA GOODE WAY
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City | SUFFOLK
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State | VA
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Zip | 23434-9236
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Country | US
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Telephone | 757-923-5559
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Fax | 757-257-0421
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | LEE B SYRIA
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Credential |
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Telephone | 828-465-8019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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