Providence Place, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PROVIDENCE PLACE, LLC

Practice address

630 Whittier Ave
High Point, NC 27262-8049

Phone

(336) 888-6760

NPI assigned

Aug 7, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lee B Syria

Title

President and Ceo

Phone

(828) 465-8019

Specialties & licenses 1

Addresses

Other names 1

• Westchester Harbour at Providence Place Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Providence Place2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Providence Place, LLC

  • Skilled Nursing Facility
  • High Point, NC
  • NPI 1700616208
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741910400000",
    "number": "1063242568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 LEONARD AVE",
            "city": "NEWTON",
            "state": "NC",
            "postal_code": "286589649",
            "telephone_number": "828-464-8264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 WHITTIER AVE",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272628049",
            "telephone_number": "336-888-6760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PLACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-07",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A",
        "authorized_official_last_name": "SYRIA",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "828-465-8019"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westchester Harbour at Providence Place",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Westchester Harbour at Providence Place",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Private Diagnostic Clinic, PLLC
• Ricky Lee Proctor, ED.D., LAT, ATC
• Progressive Vision Optometric Group P.a.
• Sophia Proscino
• Providence Place Assisted Living, Inc.
• Providence Place, LLC
• Bobbie Pruitt
• Pruitthealth - High Point, LLC
• Publix North Carolina, LP
• Thanuja Kumari Puchakayala, MD

• Assisted Living Facility in High Point, NC
• Providers in High Point, NC by specialty
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.