NPIMap

Organization Active NPI

Lookout Mountain Community Services

  • Community/Behavioral Health Agency
  • Trenton, GA
National Provider Identifier
1124190962
Registry record updated Feb 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LOOKOUT MOUNTAIN COMMUNITY SERVICES
Practice address
12580 North Main St.
Trenton, GA 30752
Phone
(706) 657-7501
Fax
(706) 657-8005
NPI assigned
Nov 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2023

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

Authorized official

Name
Alicia Michelle Howard
Title
Credentialing
Phone
(706) 670-1080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

12580 North Main St.
Trenton, GA 30752

Mailing address

PO Box 1027
La Fayette, GA 30728-1027
Phone (706) 638-5584

Other identifiers 1

IdentifierTypeStateIssuer
00604513H-42MedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040506000251 GA Part B Supplier - Clinic/Group Practice 4880682822 Receives reassigned benefits from 28 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: La Fayette, GA; Ft. Oglethorpe, GA; Trenton, GA; Summerville, GA

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Lookout Mountain Community Services107 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

Locations

12580 N Main St
Trenton, GA 30752
Phone (706) 657-7501

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675987200000",
    "number": "1124190962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1027",
            "city": "LA FAYETTE",
            "state": "GA",
            "postal_code": "307281027",
            "telephone_number": "706-638-5584",
            "fax_number": "706-638-5585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12580 NORTH MAIN ST.",
            "city": "TRENTON",
            "state": "GA",
            "postal_code": "30752",
            "telephone_number": "706-657-7501",
            "fax_number": "706-657-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOOKOUT MOUNTAIN COMMUNITY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "706-670-1080"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00604513H-42",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Trenton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.