LAKE OCONEE ASSISTED LIVING HOME (NPI# 1114121845) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114121845 |
| Entity Type | Organization |
| Organization Name | LAKE OCONEE ASSISTED LIVING HOME |
| Practice Address |
105 Wilson St Greensboro GA 30642-1426 |
| Mailing Address |
Po Box 1152 105 Wilson Street Greensboro GA 30642-8152 |
| Practice Telephone | 7064537155 |
| Practice Fax Number | 7064534156 |
| Mailing Telephone | 7064537155 |
| Mailing Fax Number | 7064534156 |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | LILLIE R TRIPP (OWNER) |
| Authorized Official Telephone | 7064539055 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0630X |
Assisted Living Facility Specialization: Assisted Living, Behavioral Disturbances |
Nursing & Custodial Care Facilities |
| Street Address |
105 WILSON ST |
| City | GREENSBORO |
| State | GA |
| Zip Code | 30642-1426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821575176 | Donald Matson Keiser IIi | Pharmacist | 6380 Lake Oconee Parkway, Greensboro, GA 30642 | 2018-07-19 |
| 1427575844 | Kathleen Mcgrady | Psychologist | 1121 Careywood St, Greensboro, GA 30642 | 2017-08-25 |
| 1851733281 | April Jackson Powell | Physical Therapist | 1000 Cowles Clinc Way Ste D-100, Greensboro, GA 30642 | 2013-07-26 |
| 1003046673 | Apalachee Medical Supply & Mobility Inc | Durable Medical Equipment & Medical Supplies | 1000 Cowles Clinic Way, Aspen Building A-200, Greensboro, GA 30642 | 2009-07-17 |
| 1487808754 | Wendy C Pearson | Nurse Practitioner | 1000 Cowles Clinc Way Ste 300, Greensboro, GA 30642 | 2008-11-12 |
| 1144481516 | Kingdom Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 1020 Park Drive, Suite B, Greensboro, GA 30642 | 2008-06-18 |
| 1538369343 | Jerry Allen Spivey Jr. | Anesthesiology | 1030 Founders Row, Greensboro, GA 30642 | 2007-07-19 |
| 1578766309 | Richard Norman Lee | Dentist | 1041 Parkside Commons, Suite 104, Greensboro, GA 30642 | 2007-06-08 |
| 1609085950 | Lott Cuffie Southwest Properties | Dentist | 1050 Parkside Commons, Suite 103, Greensboro, GA 30642 | 2007-05-22 |
| 1649320490 | Greene County Nursing Center LLC | Skilled Nursing Facility | 1211 Siloam Road, Greensboro, GA 30642 | 2007-01-12 |
| Find all providers in zip 30642 | ||||
| Taxonomy Code | 3104A0630X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Behavioral Disturbances |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700124336 | Abundant Faith Mental Health Services | Assisted Living Facility | 4217 Youngstown Dr, Greensboro, NC 27405-9740 | 2013-01-16 |
| 1235370099 | One At A Time Alternativr Assisted Living | Assisted Living Facility | 5401 Davis Mill Rd, Greensboro, NC 27406-9126 | 2009-03-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689202681 | Pt Hills Place Terraces LLC | Assisted Living Facility | 229 Peachtree Hills Place, Atlanta, GA 30305 | 2020-03-27 |
| 1477180883 | A Certain Lad Ministries Inc. | Assisted Living Facility | 693 Shannon Way, Lawrenceville, GA 30044-6310 | 2020-03-25 |
| 1174067276 | Care of Latrelle, LLC | Assisted Living Facility | 127 Waverly Way, Savannah, GA 31407-5032 | 2016-12-07 |
| 1760827190 | Distinctively Yours of Georgia, Inc | Assisted Living Facility | 8435 Magnolia Dr, Jonesboro, GA 30238-3132 | 2013-04-29 |
| 1407191257 | Litchfield Homes LLC | Assisted Living Facility | 4925 Bridle Point Pkwy, Snellville, GA 30039-3343 | 2012-12-05 |
| 1104118108 | Beth'el Personal Care Home | Assisted Living Facility | 4327 Webb Meadows Dr, Loganville, GA 30052-7579 | 2011-05-09 |
| 1003117615 | The Mary Washington Assisted Living Home, Inc | Assisted Living Facility | 590 Mountain Oaks Pkwy, Stone Mountain, GA 30087-4732 | 2010-11-12 |
| 1275898363 | Heavenly Arms Assisted Living | Assisted Living Facility | 11230 Highway 278 E, Covington, GA 30014-1673 | 2012-07-05 |
| 1508151176 | Georgia Residential and Community Healthcare, Inc | Assisted Living Facility | 5644 Hunters Crossing Ct, Lithonia, GA 30038-1529 | 2011-06-12 |
| City | GREENSBORO |
| Zip Code | 30642 |
Please comment or provide details below to improve the information on LAKE OCONEE ASSISTED LIVING HOME.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.