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KINGDOM CARE SERVICE CENTER
NPI 1194917617
Assisted Living Facility - Assisted Living, Behavioral Disturbances in Greensboro, GA

Active since August 17, 2007
107 E BROAD ST, GREENSBORO, GA 30642(706) 453-9055(706) 453-4156 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 21, 2022, Mar 17, 2018, Sep 17, 2017 (3 updates tracked since 2017).

About Kingdom Care Service Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KINGDOM CARE SERVICE CENTER (NPI 1194917617) is a healthcare organization registered as an assisted living, behavioral disturbances in Greensboro, Georgia and active in the NPI registry since August 2007. The organization maintains a secondary practice location in Sparta and lists Lillie R. Tripp, Controlling Manager, as its authorized official.

NPPES Registry Identity

NPI1194917617
Entity TypeOrganization
Primary Taxonomy3104A0630X
Legal Business NameLAKE OCONEE ASSISTED LIVING, LLC
Location Address107 E BROAD STGreensboro, GA 30642-1337
Mailing Address107 E Broad St, P.o. Box 1152Greensboro, GA 30642-1337 · (706) 453-9055 · Fax (706) 453-4156
Phone(706) 453-9055
Fax(706) 453-4156
Organization SubpartNo
Authorized OfficialLillie R. TrippControlling Manager · (706) 453-9055
Enumeration DateAugust 17, 2007
Last NPPES UpdateJuly 21, 20223 updates tracked since enumeration
✔ NPI 1194917617 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyAssisted Living Facility · Assisted Living, Behavioral DisturbancesNursing & Custodial Care Facilities
Taxonomy Code3104A0630X
License✔ Licensed in GA · CLA001142
Definition
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.
Also ListedClinic/Center · Adult Day CareTaxonomy 261QA0600X
Also ListedClinic/Center · Developmental DisabilitiesTaxonomy 261QD1600X
107 E BROAD ST, Greensboro, GA 30642
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Other Names 1

Doing Business AsKingdom Care Service Center

Secondary Practice Location 1

Location 1732 Linton RdSparta, GA 31087-3033 · Phone (706) 817-9618 · Fax (706) 453-4156

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MONICA TRIPP
Behavior Analyst
107 E BROAD ST
GREENSBORO, GA 30642
Greene County (706) 453-9055

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Oconee Assisted Living, LLC's NPI number?

The NPI number for Lake Oconee Assisted Living, LLC is 1194917617. It was assigned to this organization in the NPPES registry on August 17, 2007. The provider is doing business as Kingdom Care Service Center.

Where is Lake Oconee Assisted Living, LLC located?

Lake Oconee Assisted Living, LLC is located at 107 E Broad St, Greensboro, GA 30642. The listed phone number is (706) 453-9055.

What is Lake Oconee Assisted Living, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility, specializing in Assisted Living, Behavioral Disturbances, with taxonomy code 3104A0630X.

When was this NPI record last updated?

The NPPES record for Lake Oconee Assisted Living, LLC was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.