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49D1002598 CLIA NUMBER - LAKE PRINCE CENTER, INC

Laboratory Demographics

CLIA Number: 49D1002598

Facility Name: LAKE PRINCE CENTER, INC

Facility Address:
100 ANNA GOODE WAY
SUFFOLK, VA
ZIP 23434
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Facility Phone Number: 757 923-5500

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver
NPI Number: 1932601747

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 49D1002598
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name LAKE PRINCE CENTER, INC
Street 100 ANNA GOODE WAY
City SUFFOLK
State VA
ZIP 23434
Phone 757 923-5500
CertificateType 4
CertificateEffectiveDate 8/12/2022
CertificateExpirationDate 8/11/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024