NPIMap

Organization Active NPI

Lookout Mountain Community Service

Doing business as Ellen St CLA

  • Community/Behavioral Health Agency
  • Summerville, GA
National Provider Identifier
1790075679
Registry record updated Apr 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LOOKOUT MOUNTAIN COMMUNITY SERVICE
Doing business as
Ellen St CLA
Practice address
341 Ellen St
Summerville, GA 30747-2025
Phone
(706) 638-5580
Fax
(706) 638-5445
NPI assigned
Apr 13, 2011
Last updated
Apr 13, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2011

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

Authorized official

Name
Dr. Tom Ford, CEO
Title
Ceo
Phone
(706) 638-5580

Specialties & licenses 1

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

Addresses

Primary practice location

341 Ellen St
Summerville, GA 30747-2025

Mailing address

PO Box 1027
La Fayette, GA 30728-1027
Phone (706) 638-5580

Other names 1

  • Ellen St CLA Doing business as

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 24

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

View all 24

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": "1302652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302652800000",
    "number": "1790075679",
    "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": "706-638-5580",
            "fax_number": "706-638-5445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341 ELLEN ST",
            "city": "SUMMERVILLE",
            "state": "GA",
            "postal_code": "307472025",
            "telephone_number": "706-638-5580",
            "fax_number": "706-638-5445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOOKOUT MOUNTAIN COMMUNITY SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-13",
        "last_updated": "2011-04-13",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-638-5580",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellen St CLA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Summerville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; 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.