# LAKE OCONEE ASSISTED LIVING HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114121845
- **Authorized official:** LILLIE R TRIPP (OWNER)
- **Authorized official phone:** (706) 453-9055

## Contact information

- **Practice address:** 105 WILSON ST, GREENSBORO, GA 30642-1426
- **Practice address phone:** (706) 453-7155
- **Practice address fax:** (706) 453-4156
- **Mailing address:** PO BOX 1152, 105 WILSON STREET, GREENSBORO, GA 30642-8152
- **Mailing address phone:** (706) 453-7155
- **Mailing address fax:** (706) 453-4156

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3104A0630X | Assisted Living Facility (Behavioral Disturbances) | — | NULL | Yes |

## Other

- **Enumeration date:** 06/14/2007
- **Last updated:** 08/22/2020