NPIMap

Organization Active NPI

Lizzy's Adult Community Service Center

  • Adult Day Care Clinic/Center
  • Grovetown, GA
National Provider Identifier
1316285315
Registry record updated Jan 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
Legal business name
LIZZY'S ADULT COMMUNITY SERVICE CENTER
Practice address
1514 Baldwin Lakes Dr
Grovetown, GA 30813-5887
Phone
(706) 533-0218
Fax
(706) 869-2015
NPI assigned
Jan 25, 2013
Last updated
Jan 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2013

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

Authorized official

Name
Mr. Melvin Parker III
Title
Administrator
Phone
(706) 533-0218

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X Primary

Addresses

Primary practice location

1514 Baldwin Lakes Dr
Grovetown, GA 30813-5887

Mailing address

1514 Baldwin Lakes Dr
Grovetown, GA 30813-5887
Phone (706) 533-0218

Other identifiers 2

IdentifierTypeStateIssuer
366878280BMedicaidGA
366878280AMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Lizzy's Adult Community Service Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1359072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359072000000",
    "number": "1316285315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 BALDWIN LAKES DR",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308135887",
            "telephone_number": "706-533-0218",
            "fax_number": "706-869-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 BALDWIN LAKES DR",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308135887",
            "telephone_number": "706-533-0218",
            "fax_number": "706-869-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIZZY'S ADULT COMMUNITY SERVICE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-25",
        "last_updated": "2013-01-25",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "MELVIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "706-533-0218",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "366878280B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "366878280A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grovetown, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2013; 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.