PROVIDENT VILLAGE AT CREEKSIDE
NPI 1891287645
Assisted Living Facility in Smyrna, GA
NPI Status: Active since June 06, 2018
Contact Information
4838 SOUTH COBB DRIVE
SMYRNA, GA
ZIP 30080
Phone: (678) 710-1834
Fax: (678) 236-0374
- Organization
- Assisted Living Facility
- CLIA Number: 11D2122676
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 12-04-2026
About PROVIDENT VILLAGE AT CREEKSIDE
This page provides the complete NPI Profile along with additional information for Provident Village At Creekside, a provider established in Smyrna, Georgia operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1891287645 assigned on June 2018. The practitioner's primary taxonomy code is 310400000X. The provider is registered as an organization and their NPI record was last updated 8 years ago. The provider's is doing business as Provident Village At Creekside. The authorized official of this NPI record is Debra W. Lockwood (President & Chief Financial Officer)
- NPI
- 1891287645
- Provider Legal Name
- PROVIDENT GROUP - CREEKSIDE PROPERTIES LLC
- Other Organization Name
- PROVIDENT VILLAGE AT CREEKSIDE
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 4838 SOUTH COBB DRIVE SMYRNA, GA 30080
- Location Phone
- (678) 710-1834
- Location Fax
- (678) 236-0374
- Mailing Address
- 5565 BANKERS AVENUE BATON ROUGE, LA 70808
- Mailing Phone
- (225) 766-3977
- Mailing Fax
- (678) 236-0374
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-06-2018
- Last Update Date
- 06-06-2018
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Assisted Living Facility
- Taxonomy Code
- 310400000X
- Type
- Nursing & Custodial Care Facilities
- Taxonomy Description
- A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 311500000X | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) | |
| 2 | 385H00000X | Respite Care Facility | Respite Care |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 11D2122676
- Facility Type
- Assisted Living Facility
- Certificate Effective Date
- December 05, 2024
- Certificate Expiration Date
- December 04, 2026
- Laboratory Director
- ELAINE AUSTIN
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Provident Village At Creekside to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1891287645, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 75. The final step is to find the difference between that total and the next multiple of ten (80 - 75 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 75 is 80. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1891287645, enumerated as an "organization" on June 06, 2018.
The provider is located at 4838 SOUTH COBB DRIVE SMYRNA, GA 30080 and the phone number is (678) 710-1834.
Assisted Living Facility with taxonomy code 310400000X.
