Lake Prince Center, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH2752 Issued in VA

Legal business name

LAKE PRINCE CENTER, INC.

Doing business as

Lake Prince Woods

Practice address

100 Anna Goode Way
Suffolk, VA 23434-9236

Phone

(757) 923-5500

Fax

(757) 923-5502

NPI assigned

Oct 3, 2005

Last updated

Jan 4, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Paula Sutton White

Title

Accounts Receivable Manager

Phone

(828) 465-8021

Specialties & licenses 1

Addresses

Other names 1

• Lake Prince Woods Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073500310. Details of each certification follow.

• CCN 495366 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 495366

Legal name

LAKE PRINCE CENTER, INC.

Doing business as

LAKE PRINCE WOODS

Certification status

Active

Provider type (POS)

Nursing home – SNF (Medicare) only

Participating since

Jan 14, 2003

Last certification

Feb 3, 2022

Beds

40

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Everyage

Organization structure

CorporationNon-profit

Incorporated

Jul 12, 1999 in NC

Enrollment address

100 Anna Goode Way
Suffolk, VA 23434-9236

Nursing home name

LAKE PRINCE WOODS, INC

Affiliated entity

EVERYAGE SENIOR LIVING

Listed as

Lake Prince Woods, IncCCN 495366 · All quality measures

Overall star rating

5 of 5

Health inspections

5 of 5

Staffing

5 of 5

Quality measures

3 of 5

Type

Medicare

Ownership

For profit - Limited Liability company

Certified

Jan 14, 2003

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4029.6 residents per day on average

Chain

Everyage Senior Living3 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Everyage

  dba Abernethy Laurels

  • Skilled Nursing Facility
  • Newton, NC
  • NPI 1245227578

  Member Of

  NPD member

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

• Lake Prince at Home LLC

  • Community Based Hospice Care Agency
  • Suffolk, VA
  • NPI 1174112445

  Member Of

  NPD member
• Lake Prince at Home LLC

  • Home Health Agency
  • Suffolk, VA
  • NPI 1932601747

  Member Of

  NPD member

All disclosed owners & managing parties 26

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Charles Erdman, M.D.

  • Emergency Medicine Physician
  • Portsmouth, VA
  • NPI 1740250687

  Adp of the SNF, Corporate Director

  CMS ownership
• Amir Hajimomenian, MD

  • Internal Medicine Physician
  • Virginia Beach, VA
  • NPI 1497735112

  Adp of the SNF

  CMS ownership
• Everyage

  dba Piedmont Crossing

  • Skilled Nursing Facility
  • Thomasville, NC
  • NPI 1124015458

  5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Everyage

  dba Abernethy Laurels

  • Skilled Nursing Facility
  • Newton, NC
  • NPI 1245227578

  5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Adp of the SNF, Operational/Managerial Control

  CMS ownership

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Lake Prince at Home LLC

  • Community Based Hospice Care Agency
  • Suffolk, VA
  • NPI 1174112445

  Operational/Managerial Control

  CMS ownership
• Lake Prince at Home LLC

  • Home Health Agency
  • Suffolk, VA
  • NPI 1932601747

  5% Or Greater Direct Ownership Interest

  CMS ownership

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Everyage

  dba Abernethy Laurels

  • Skilled Nursing Facility
  • Newton, NC
  • NPI 1245227578

  Everyage

  CMS ownership
• Providence Place, LLC

  • Skilled Nursing Facility
  • High Point, NC
  • NPI 1700616208

  Everyage

  CMS ownership

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Lake Prince at Home LLC

  • Home Health Agency
  • Suffolk, VA
  • NPI 1932601747
  NPPES parent name

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• William G Jackson, MD

  • Family Medicine Physician
  • Suffolk, VA
  • NPI 1760481717

  Nursing home

  Care Compare affiliation
• Alice Rebecca Morris, FNP

  • Family Nurse Practitioner
  • Norfolk, VA
  • NPI 1043811144

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609718400000",
    "number": "1073500310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ANNA GOODE WAY",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234349236",
            "telephone_number": "757-923-5500",
            "fax_number": "757-923-5502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 ANNA GOODE WAY",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234349236",
            "telephone_number": "757-923-5500",
            "fax_number": "757-923-5502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE PRINCE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "SUTTON",
        "authorized_official_title_or_position": "ACCOUNTS RECEIVABLE MANAGER",
        "authorized_official_telephone_number": "828-465-8021"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VA",
            "license": "NH2752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Prince Woods",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Prince Woods",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristina N. Lacour, FNP-C
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• Skilled Nursing Facility in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Skilled Nursing Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.