NPIMap

Organization Active NPI

Sunnyside Presbyterian Home

  • Skilled Nursing Facility
  • Martinsville, VA
National Provider Identifier
1366431652
Registry record updated May 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH2602 Issued in VA
Legal business name
SUNNYSIDE PRESBYTERIAN HOME
Practice address
350 Kings Way Rd
Martinsville, VA 24112-6631
Phone
(276) 634-1000
Fax
(276) 634-1599
NPI assigned
Oct 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2020

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

Authorized official

Name
Mr. Paul White
Title
Controller
Phone
(540) 568-8237

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X RO05417 VA
Skilled Nursing Facility 314000000X NH2602 VA Primary

Addresses

Primary practice location

350 Kings Way Rd
Martinsville, VA 24112-6631

Mailing address

600 University Blvd
Harrisonburg, VA 22801-3763
Phone (540) 568-8237

Other identifiers 1

IdentifierTypeStateIssuer
4954081MedicaidVA

Other names 1

  • King's Grant Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100622000135 VA Part A Provider - Skilled Nursing Facility 9739107665 Practice locations: Martinsville, VA

Skilled nursing facility certification: CCN 495408

Legal name
SUNNYSIDE PRESBYTERIAN HOME
Doing business as
KINGS GRANT
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 30, 2010
Last certification
Sep 14, 2023
Beds
32
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Sunnyside Presbyterian Homes
Organization structure
OtherNon-profit
Enrollment address
350 Kings Way Road
Martinsville, VA 24112-6631
Nursing home name
KING'S GRANT LACY HEALTH CENTER

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
King'S Grant Lacy Health CenterCCN 495408
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Nov 30, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
3229.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0861010Kings Grant Retirement Community350 Kings Way Road, Martinsville, VA 24112Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Sunnyside Presbyterian Home6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Member organizations 2

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
James L Souter Individual W-2 Managing Employee Apr 1, 2021
Joshua Lyons Individual Operational/Managerial ControlPresident & Ceo Mar 1, 2020
James Rowe Individual Corporate Officer Oct 31, 1993

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
First Choice Home Health Services, LLCHarrisonburg, VA, CCN 497320 Home health agency 5% Or Greater Direct Ownership Interest (33%) Jan 1, 2015
First Choice HospiceHarrisonburg, VA, CCN 491620 Hospice 5% Or Greater Direct Ownership Interest (33%) Jan 1, 2015

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 5

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

NPI Registry JSON

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590451200000",
    "number": "1366431652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 UNIVERSITY BLVD",
            "city": "HARRISONBURG",
            "state": "VA",
            "postal_code": "228013763",
            "telephone_number": "540-568-8237",
            "fax_number": "540-568-8248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 KINGS WAY RD",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241126631",
            "telephone_number": "276-634-1000",
            "fax_number": "276-634-1599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNNYSIDE PRESBYTERIAN HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-19",
        "last_updated": "2020-05-26",
        "certification_date": "2020-05-26",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "540-568-8237",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "VA",
            "license": "RO05417",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VA",
            "license": "NH2602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4954081",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "King's Grant",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Martinsville, VA

Sources for this page

Verify at the official NPI Registry.