Lake Oconee Assisted Living, LLC

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

License

CLA001142 Issued in GA

Legal business name

LAKE OCONEE ASSISTED LIVING, LLC

Doing business as

Kingdom Care Service Center

Practice address

107 E Broad St
Greensboro, GA 30642-1337

Phone

(706) 453-9055

Fax

(706) 453-4156

NPI assigned

Aug 17, 2007

Last updated

Jul 21, 2022By the provider in NPPES

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

Controlling Manager

Phone

(706) 453-9055

Specialties & licenses 3

Addresses

Other names 1

• Kingdom Care Service Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Monica Tripp

  • Behavior Analyst
  • Greensboro, GA
  • NPI 1982159265
  NPD (past)

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

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1194917617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 E BROAD ST",
            "address_2": "P.O. BOX 1152",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "306421337",
            "telephone_number": "706-453-9055",
            "fax_number": "706-453-4156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E BROAD ST",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "306421337",
            "telephone_number": "706-453-9055",
            "fax_number": "706-453-4156"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "732 Linton Rd",
            "address_purpose": "LOCATION",
            "city": "Sparta",
            "state": "GA",
            "postal_code": "310873033",
            "country_code": "US",
            "telephone_number": "706-817-9618",
            "fax_number": "706-453-4156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE OCONEE ASSISTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-17",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "TRIPP",
        "authorized_official_first_name": "LILLIE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "CONTROLLING  MANAGER",
        "authorized_official_telephone_number": "706-453-9055"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "GA",
            "license": "CLA001142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kingdom Care Service Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kingdom Medical Supply LLC
• Arun Kumar, M.D
• Karissa Joy Lacy, DC
• Lake Medical Center
• Lake Oconee Assisted Living Home
• Lake Oconee Endodontics, LLC
• Lake Oconee Foot and Ankle LLC
• Lake Oconee Oral and Maxillofacial Surgery, P.C.
• Lake Oconee Orthopedics, LLC
• Lakeside Pediatric Dentistry, 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 Jul 21, 2022; 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.