NPIMap

Organization Active NPI

Professional Resources Management of Rabun LLC

Doing business as Mountain Lakes Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Clayton, GA
National Provider Identifier
1265560726
Registry record updated Jun 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
119621 Issued in GA
Legal business name
PROFESSIONAL RESOURCES MANAGEMENT OF RABUN LLC
Doing business as
Mountain Lakes Medical Center
Practice address
162 Legacy PT
Clayton, GA 30525-5354
Phone
(706) 782-3100
NPI assigned
Feb 28, 2007
Last updated
Jun 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2025

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

Authorized official

Name
Kristy Hall
Title
Ceo
Phone
(706) 782-0400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 119621 GA Primary

Addresses

Primary practice location

162 Legacy PT
Clayton, GA 30525-5354

Mailing address

162 Legacy PT
Clayton, GA 30525-5354
Phone (706) 782-3100

Other identifiers 1

IdentifierTypeStateIssuer
00001559SMedicaidGA

Other names 1

  • MOUNTAIN LAKES MEDICAL CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080325000518 GA Part A Provider - Critical Access Hospital 1052342854 Practice locations: Clayton, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265560726. Details of each certification follow.

Hospital certification: CCN 11Z336

Legal name
PROFESSIONAL RESOURCES MANAGEMENT OF RABUN LLC
Doing business as
MOUNTAIN LAKES MEDICAL CENTER
Organization structure
LLCProprietary
Incorporated
Dec 17, 2004 in AL
Enrollment address
162 Legacy PT
Clayton, GA 30525-5354
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Prof Resur O Rabun LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

162 Legacy Pt
Ste C
Clayton, GA 30525
Phone (706) 960-9533

815 John Beck Dockins Rd
Rabun Gap, GA 30568
Phone (706) 746-5004

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
RJ Capital LLC Organization, Herndon, VA LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 22, 2020 38.41%
Kristy Hall Individual Corporate OfficerCeo Dec 8, 2022
Corporate DirectorCeo Dec 8, 2022
W-2 Managing EmployeeCeo Dec 8, 2022
MHL Partners LLC Organization, Clayton, GA Created for acquisition, LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 22, 2020 66%
Robert Lubin Individual 5% Or Greater Indirect Ownership Interest Jun 22, 2020 54.91%
ML Healthcare LP Organization, Herndon, VA Created for acquisition, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 22, 2020 34%
5% Or Greater Indirect Ownership Interest Jun 22, 2020 49.5%
Norma Sullivan Individual Corporate OfficerCfo Mar 1, 2023
Corporate DirectorCfo Mar 1, 2023
W-2 Managing EmployeeCfo Mar 1, 2023

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750636800000",
    "number": "1265560726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 LEGACY PT",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305255354",
            "telephone_number": "706-782-3100",
            "fax_number": "706-782-6897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 LEGACY PT",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305255354",
            "telephone_number": "706-782-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL RESOURCES MANAGEMENT OF RABUN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-782-0400"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "GA",
            "license": "119621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00001559S",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOUNTAIN LAKES MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MOUNTAIN LAKES MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clayton, GA

Sources for this page

Verify at the official NPI Registry.