EMERITUS AT LAKE RIDGE
NPI 1104034412
Assisted Living Facility in Woodbridge, VA

Q: What is Summerville At Prince William, Inc's NPI number?

The NPI number for Summerville At Prince William, Inc is 1104034412. It was assigned to this organization in the NPPES registry on May 18, 2007. The provider is doing business as Emeritus At Lake Ridge.

Q: What is Summerville At Prince William, Inc's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Active since May 18, 2007

3940 PRINCE WILLIAM PKWY, WOODBRIDGE, VA 22192(703) 680-0600(703) 680-0790 Get Directions Write a Review

NPPES record last updated: September 9, 2009. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Emeritus At Lake Ridge NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EMERITUS AT LAKE RIDGE (NPI 1104034412) is a healthcare organization registered as an assisted living facility in Woodbridge, Virginia and active in the NPI registry since May 2007. The organization lists Noelle Diaz, Licensing Specialist, as its authorized official.

NPPES Registry Identity

NPI1104034412

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameSUMMERVILLE AT PRINCE WILLIAM, INC

Location Address3940 PRINCE WILLIAM PKWYWoodbridge, VA 22192-4513

Mailing Address3131 Elliott Ave, Suite 500Seattle, WA 98121-1032 · (206) 298-2909 · Fax (206) 301-4500

Phone(703) 680-0600

Fax(703) 680-0790

Organization SubpartNo

Authorized OfficialNoelle DiazLicensing Specialist · (206) 298-2909

Enumeration DateMay 18, 2007

Last NPPES UpdateSeptember 9, 2009

✔ NPI 1104034412 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

License✔ Licensed in VA · WLO-03-780

Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Also ListedAlzheimer Center (Dementia Center)Taxonomy 311500000X · License WLO-03-780 (VA)

3940 PRINCE WILLIAM PKWY, Woodbridge, VA 22192

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Other Names 1

Doing Business AsEmeritus At Lake Ridge

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROBERTA T. HARE PTA

Physical Therapy Assistant