Lookout Mountain Community Services
Organization Active NPI Community/Behavioral Health Agency · Summerville, GA
NPI 1720150907 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1720150907
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- LOOKOUT MOUNTAIN COMMUNITY SERVICES
- Practice address
- 83 Highway 48
Summerville, GA 30747-1506 - Phone
- (706) 857-5441
- Fax
- (706) 857-7607
- NPI assigned
- Nov 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Thomas W. Ford, PH.D.
- Title
- Executive Director
- Phone
- (706) 638-5584
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 24
Practitioners 6
-
Dawn Davis, LPC
-
David C Morton, M.D.
-
Michael W Free, LCSW
-
Shannon Owensby, RN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Lookout Mountain Community Services
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
83 Highway 48
Summerville, GA 30747-1506
Mailing address
PO Box 1027
La Fayette, GA 30728-1027
Phone (706) 638-5584
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00604513E-32 | Medicaid | GA |
Other providers in Summerville, GA
- Lookout Mountain Community Services
- Lookout Mountain Community Services
- Lookout Mountain Community Services
- Lookout Mountain Community Services
- Lookout Mountain Community Services
- Lookout Mountain Community Services
- Lookout Mountain Community Services
- Lookout Mountain Community Services
- Lookout Mountain Community Services
- Lookout Mountain Community Services
All providers in Summerville, GA · Community/Behavioral Health Agency in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.