Provider Demographics
NPI:1174112445
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:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SYRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-465-8019
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:757-923-5559
Mailing Address - Fax:757-257-0421
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:757-923-5559
Practice Address - Fax:757-257-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based