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Lake Oconee Assisted Living, LLC — NPI 1194917617, Greensboro, GA | NPI Central

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NPI 1194917617

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Lake Oconee Assisted Living, LLC

NPI 1194917617 · Assisted Living Facility (Behavioral Disturbances) · Greensboro, GA

Provider details

NPI number: 1194917617
Entity type: Organization
Primary specialty: Assisted Living Facility (Behavioral Disturbances)Nursing & Custodial Care Facilities
Organization subpart: No
Authorized official: Lillie Tripp, Controlling Manager(706) 453-9055

Specialties & taxonomies

Assisted Living Facility (Behavioral Disturbances)Primary3104A0630XLicense CLA001142 (GA)
Nursing & Custodial Care Facilities
Adult Day Care Clinic/Center261QA0600X
Ambulatory Health Care Facilities
Developmental Disabilities Clinic/Center261QD1600X
Ambulatory Health Care Facilities

Practice location

107 E Broad St

Greensboro, GA 30642-1337

Phone: (706) 453-9055

Fax: (706) 453-4156

Approximate (ZIP-level) locationGet directions

More GA providers

Mailing address

107 E Broad St

Greensboro, GA 30642-1337

Other names (DBA / former)

Doing business as: Kingdom Care Service Center

Additional practice locations (1)

732 Linton Rd
Sparta, GA 31087-3033
Phone: (706) 817-9618
Fax: (706) 453-4156

Registry dates

Enumerated: 2007-08-17
Last updated: 2022-07-21

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.