LAKE OCONEE ASSISTED LIVING LLC NPI 1194917617

NPI Information

  • NPI: 1194917617
  • Provider Name: LAKE OCONEE ASSISTED LIVING, LLC
  • Classification: Assisted Living Facility - 3104A0630X
  • Specialization: Assisted Living, Behavioral Disturbances
  • Entity Type: Organization
  • Doing Business As: KINGDOM CARE SERVICE CENTER
  • Address: 107 E BROAD ST
    GREENSBORO, GA
    ZIP 30642
  • Phone: (706) 453-9055

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NPI Details

LAKE OCONEE ASSISTED LIVING, LLC is an assisted living and behavioral disturbances assisted living facility in Greensboro, GA. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors. LAKE OCONEE ASSISTED LIVING, LLC NPI is 1194917617. The provider is registered as an organization entity type.
The provider Is Doing Business As Kingdom Care Service Center.

The provider's business location address is:

107 E BROAD ST
GREENSBORO, GA
ZIP 30642-337
Phone: (706) 453-9055
Fax: (706) 453-4156

The provider's authorized official is Lillie R. Tripp .
The authorized official title is CONTROLLING MANAGERManager and has the following contact phone number (706) 453-9055.

The enumeration date for this NPI number is 8/17/2007 and was last updated on 7/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QA0600XClinic/CenterAdult Day CareNo
2261QD1600XClinic/CenterDevelopmental DisabilitiesNo
33104A0630XAssisted Living FacilityAssisted Living, Behavioral DisturbancesCLA001142GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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