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
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
CLA001142
GA
Other
Enumeration date
08/17/2007
Last updated
07/21/2022
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