Active NPI
Lake Prince at Home LLC
- Home Health Agency
- Suffolk, VA
National Provider Identifier
1932601747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- LAKE PRINCE AT HOME LLC
- Practice address
- 100 Anna Goode Way
Suffolk, VA 23434-9236 - Phone
- (757) 923-5500
- NPI assigned
- Mar 7, 2018
- Last updated
- Mar 14, 2025
- Organization subpart
- Yes
- Parent organization
- LAKE PRINCE CENTER, INC.
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | NU | Primary |
Addresses
Primary practice location
100 Anna Goode Way
Suffolk, VA 23434-9236
Mailing address
100 Leonard Ave
Newton, NC 28658-9649
Phone (828) 465-8021
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181214000523 | VA | Part A Provider - Home Health Agency | 7113262429 | Practice locations: Suffolk, VA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1932601747. Details of each certification follow.
Home health agency certification: CCN 497763
- Legal name
- LAKE PRINCE AT HOME LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Apr 25, 2019
- Last certification
- Apr 25, 2019
- Ownership / control type
- Non-Profit
- Organization structure
- LLC
- Incorporated
- Oct 16, 2017 in NC
- Enrollment address
- 100 Anna Goode Way
Suffolk, VA 23434-9236
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Lake Prince at Home LLC
- Overall star rating
- Ownership
- Non-Profit
- Certified
- Apr 25, 2019
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider Directory- Tax ID family
- Lake Prince at Home LLC
- Part of
- Lake Prince Center Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community Based Hospice Care Agency
- Suffolk, VA
- NPI 1174112445
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Lake Prince Woods
- Skilled Nursing Facility
- Suffolk, VA
- NPI 1073500310
Member Of
Ownership & related parties
All disclosed owners & managing parties 27
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Jeffrey J Gilliam | Corporate Director | Oct 1, 2024 | |
| Tammy Jones | Corporate Officer | Feb 1, 2023 | |
| Lamont D Maddox | Corporate Director | Oct 1, 2024 | |
| Anthony Branch | Corporate Director | Oct 1, 2024 | |
| Gregory Alcorn | Corporate Director | Oct 1, 2024 | |
| Michelle Horton | Corporate Director | Oct 1, 2024 | |
| Kathy Wood | Corporate Director | Oct 1, 2024 | |
| Kenneth Wayne Clapp | Corporate Director | Oct 1, 2025 | |
| Paul Allen Gray | Corporate Director | Oct 1, 2024 | |
| Diana R Sullivan | Corporate Director | Oct 1, 2024 | |
| Margaret N Wiley | Corporate Director | Oct 1, 2024 | |
| Parker Daughtry Howell | Corporate Director | Oct 1, 2024 | |
| Heather Sloan | Corporate Officer | Apr 12, 2025 | |
| Amir Hajimomenian | Contracted Managing Employee | Oct 1, 2024 | |
| Susan Stone | Corporate Director | Oct 1, 2025 | |
| Lawrence Ray Bolick | Corporate Director | Oct 1, 2024 | |
| Shane Smith | Corporate Director | Oct 1, 2024 | |
| Julius W Abernethy | Corporate Director | Oct 1, 2024 | |
| Jody Street | Corporate Director | Oct 1, 2024 | |
| Ronald Bradley Thie | Corporate Director | Oct 1, 2024 | |
| Charles W Erdman | Corporate Director | Oct 1, 2024 | |
| Aimee N Reimann | Corporate Officer | Oct 17, 2017 | |
| Mills Hunter March | Corporate Director | Oct 1, 2024 | |
| Lee B Syria | Corporate Officer | Oct 1, 2012 | |
| Katrina Esterly | W-2 Managing Employee | May 4, 2026 | |
| Lake Prince Center, Inc. | 5% Or Greater Direct Ownership Interest | Oct 16, 2017 | 100% |
| Cory Scott Tobin | Corporate Director | Oct 1, 2024 |
Owners & managing parties with NPI records 3
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Virginia Beach, VA
- NPI 1497735112
Contracted Managing Employee
-
dba Lake Prince Woods
- Skilled Nursing Facility
- Suffolk, VA
- NPI 1073500310
5% Or Greater Direct Ownership Interest
Facilities with the same owner 1
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Community Based Hospice Care Agency
- Suffolk, VA
- NPI 1174112445
Lake Prince Center, Inc.
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
Practitioners & affiliated clinicians
Affiliated clinicians 20
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Internal Medicine Physician
- Suffolk, VA
- NPI 1750344230
Home health agency
-
- Orthopaedic Surgery Physician
- Suffolk, VA
- NPI 1912903998
Home health agency
-
- Internal Medicine Physician
- Chesapeake, VA
- NPI 1649341678
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520380800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1741910400000",
"number": "1932601747",
"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": "828-465-8021",
"fax_number": "828-465-8015"
},
{
"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"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAKE PRINCE AT HOME LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LAKE PRINCE CENTER, INC.",
"enumeration_date": "2018-03-07",
"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": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suffolk, VA
Sources for this page
- 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 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.