Lake Oconee Assisted Living Home

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

Legal business name

LAKE OCONEE ASSISTED LIVING HOME

Practice address

105 Wilson St
Greensboro, GA 30642-1426

Phone

(706) 453-7155

Fax

(706) 453-4156

NPI assigned

Jun 14, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lillie R Tripp

Title

Owner

Phone

(706) 453-9055

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114121845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1152",
            "address_2": "105 WILSON STREET",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "306428152",
            "telephone_number": "706-453-7155",
            "fax_number": "706-453-4156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 WILSON ST",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "306421426",
            "telephone_number": "706-453-7155",
            "fax_number": "706-453-4156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE OCONEE ASSISTED LIVING HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TRIPP",
        "authorized_official_first_name": "LILLIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-453-9055"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Adrian King, DPT
• Kingdom Medical Supply LLC
• Arun Kumar, M.D
• Karissa Joy Lacy, DC
• Lake Medical Center
• Lake Oconee Assisted Living, LLC (Kingdom Care Service Center)
• Lake Oconee Endodontics, LLC
• Lake Oconee Foot and Ankle LLC
• Lake Oconee Oral and Maxillofacial Surgery, P.C.
• Lake Oconee Orthopedics, LLC

• Assisted Living Facility (Behavioral Disturbances) in Greensboro, GA
• Providers in Greensboro, GA by specialty
• Assisted Living Facility (Behavioral Disturbances) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.