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Organization
LAKE OCONEE ASSISTED LIVING, LLC
Active
Organization
LAKE OCONEE ASSISTED LIVING, LLC
Active
Other names
Kingdom Care Service Center
Organization subpart
No
Provider details
NPI number
Authorized official
LILLIE R. TRIPP (CONTROLLING MANAGER)
(706) 453-9055
Entity
Organization
Contact information
Practice address
107 E BROAD ST, GREENSBORO, GA 30642-1337
(706) 453-9055
(706) 453-4156
Mailing address
107 E BROAD ST, P.O. BOX 1152, GREENSBORO, GA 30642-1337
(706) 453-9055
(706) 453-4156
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
—
NULL
261QD1600X
Developmental Disabilities Clinic/Center
—
NULL
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
CLA001142
GA
Other
Enumeration date
08/17/2007
Last updated
07/21/2022
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