Providence Place, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PROVIDENCE PLACE, LLC

Practice address

1795 Westchester Dr
High Point, NC 27262-7008

Phone

(828) 464-8264

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/Ceo

Phone

(828) 465-8019

Specialties & licenses 1

Addresses

Other names 1

• Westchester Manor at Providence Place Other name

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Skilled nursing facility certification: CCN 345090

Legal name

PROVIDENCE PLACE, LLC

Doing business as

WESTCHESTER MANOR AT PROVIDENCE PLACE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

May 1, 1973

Last certification

May 23, 2024

Beds

129

Ownership / control type

Nonprofit Corporation

Multi-facility organization

Everyage

Organization structure

LLC

Enrollment address

1795 Westchester Dr
High Point, NC 27262-7008

Nursing home name

WESTCHESTER MANOR AT PROVIDENCE PLACE

Affiliated entity

EVERYAGE SENIOR LIVING

Listed as

Westchester Manor at Providence PlaceCCN 345090

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

4 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

May 1, 1973

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

129118.9 residents per day on average

Chain

Everyage Senior Living3 facilities in the chain

Penalties (3 years)

1Fines totaling $8,018

Processed by Care Compare on Aug 1, 2026.

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

  • Assisted Living Facility
  • High Point, NC
  • NPI 1063242568
  NPD tax ID

Member of 1

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

• Everyage

  • Skilled Nursing Facility
  • Newton, NC
  • NPI 1245227578

  Member Of

  NPD member

All disclosed owners & managing parties 28

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.

• Everyage

  • 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

  • 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
• Venezela Thomas Slade-Hartman, M.D.

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1083690036

  Adp of the SNF

  CMS ownership
• Charles Erdman, M.D.

  • Emergency Medicine Physician
  • Portsmouth, VA
  • NPI 1740250687

  Adp of the SNF, Corporate Director, Managing Control - Governing Body

  CMS ownership

Facilities with the same owner 2

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

• Everyage

  • Skilled Nursing Facility
  • Newton, NC
  • NPI 1245227578

  Everyage

  CMS ownership
• Lake Prince Center, Inc.

  • Skilled Nursing Facility
  • Suffolk, VA
  • NPI 1073500310

  Everyage

  CMS ownership

Practitioners 1

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

• Venezela Thomas Slade-Hartman, M.D.

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1083690036
  NPD (past)

Affiliated clinicians 1

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

• Venezela Thomas Slade-Hartman, M.D.

  • Family Medicine Physician
  • Winston Salem, NC
  • NPI 1083690036

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1722988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761004800000",
    "number": "1700616208",
    "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": "1795 WESTCHESTER DR",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272627008",
            "telephone_number": "828-464-8264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PLACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-07",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A",
        "authorized_official_last_name": "SYRIA",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "828-465-8019"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westchester Manor at Providence Place",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Westchester Manor at Providence Place",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• 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
• Scott Zachary Pugh, DMD

• All providers in High Point, NC
• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2025; 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.