WICKSHIRE PORT ORANGE OPCO LLC (NPI# 1023616943) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023616943 |
| Entity Type | Organization |
| Organization Name | WICKSHIRE PORT ORANGE OPCO LLC |
| Practice Address |
1675 Dunlawton Ave Port Orange FL 32127-4755 |
| Mailing Address |
750 Old Hickory Blvd Brentwood TN 37027-4528 |
| Practice Telephone | 3867611055 |
| Mailing Telephone | 6159420240 |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2020-10-13 |
| Authorized Official Name | DAN O'KEEFE (CEO) |
| Authorized Official Telephone | 6159420240 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311500000X | Alzheimer Center (Dementia Center) | Nursing & Custodial Care Facilities | ||
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Wickshire Port Orange | Doing Business As Name - Organization |
| Street Address |
1675 DUNLAWTON AVE |
| City | PORT ORANGE |
| State | FL |
| Zip Code | 32127-4755 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811192636 | Eric W Harting | Physical Therapy Assistant | 1675 Dunlawton Ave, Port Orange, FL 32127-4755 | 2007-06-20 |
| 1649765256 | Hcp Port Orange Fl Opco, LLC | Assisted Living Facility | 1675 Dunlawton Ave, Port Orange, FL 32127-4755 | 2018-06-26 |
| 1972838886 | Mary Elizabeth Uyttewaal | Speech-Language Pathologist | 1675 Dunlawton Ave, Port Orange, FL 32127-4755 | 2009-10-09 |
| 1750545158 | Summerville At Port Orange, Inc. | Alzheimer Center (Dementia Center) | 1675 Dunlawton Ave, Port Orange, FL 32127-4755 | 2008-07-15 |
| 1801069109 | Yvonne J Thompson | Physical Therapy Assistant | 1675 Dunlawton Ave, Port Orange, FL 32127-4755 | 2008-04-08 |
| 1699953018 | Leslie N Cook | Physical Therapy Assistant | 1675 Dunlawton Ave, Port Orange, FL 32127-4755 | 2008-02-07 |
| 1720260292 | Robin P Edson | Physical Therapy Assistant | 1675 Dunlawton Ave, Port Orange, FL 32127-4755 | 2007-11-27 |
| 1295916096 | Theresa L Hyatt | Physical Therapy Assistant | 1675 Dunlawton Ave, Port Orange, FL 32127-4755 | 2007-11-20 |
| 1720270960 | Kelly L Adams | Speech-Language Pathologist | 1675 Dunlawton Ave, Port Orange, FL 32127-4755 | 2007-08-13 |
| 1578753745 | Traci L. Fox | Occupational Therapist | 1675 Dunlawton Ave, Port Orange, FL 32127-4755 | 2007-07-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952918179 | Karen Lugo Morales | Massage Therapist | 1394 Dunlawton Ave, Apartment 505, Port Orange, FL 32127 | 2020-09-30 |
| 1265952568 | Compass Nutrition LLC | Dietitian, Registered | 840 Angelina Court, Port Orange, FL 32127 | 2017-06-27 |
| 1942730544 | Ambili Gopinathan Nair | Nurse Anesthetist, Certified Registered | 6216 Morning Drive, Port Orange, FL 32127 | 2017-06-15 |
| 1649707993 | Jill Lynn Sheldon | Social Worker | 3959 South Nova Road, Suiteb15, Port Orange, FL 32127 | 2017-05-17 |
| 1003350620 | Irene A Zachry | Interpreter | 6239 Yellowstone Dr. Port Orange Fl, Port Orange, FL 32127 | 2016-12-16 |
| 1427460328 | Jonathan Ivan Rodriguez Arocho | Chiropractor | 940 Village Trail, Unit 4-105, Port Orange, FL 32127 | 2014-05-27 |
| 1982015913 | Adventist Health System/sunbelt, Inc. | Clinic/Center | 1208 Dunlawton Ave, Port Orange, FL 32127 | 2014-05-13 |
| 1699105288 | Counseling & Consultation, Corp. | Early Intervention Provider Agency | 3959 S. Nova Rd., Suite 14, Port Orange, FL 32127 | 2013-11-18 |
| 1427484773 | Usv Optical Inc. | Technician/Technologist | 1800 Dunlawton Ave., Port Orange, FL 32127 | 2013-09-18 |
| 1104194018 | Jinny E Ruhlman | Marriage & Family Therapist | 4725 Dixie Dr, Ponce Inlet, FL 32127 | 2011-12-06 |
| Find all providers in zip 32127 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| 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. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407467806 | Heavenly Assisted Living, Inc. | Assisted Living Facility | 401 Orange Ave, Port Orange, FL 32127-4444 | 2020-08-11 |
| 1619463007 | Angel's Senior Living II, LLC | Assisted Living Facility | 5855 Boggs Ford Rd, Port Orange, FL 32127-5870 | 2018-07-09 |
| 1508212010 | Pat's Loving Care Alf Inc. | Assisted Living Facility | 3783 Birch Mountain Rd, Port Orange, FL 32129-3770 | 2016-05-13 |
| 1275917130 | Coquina Cay Assisted Living | Assisted Living Facility | 5773 Pendlebury Ct, Port Orange, FL 32127-7960 | 2015-07-10 |
| 1699168468 | La Poinciana Alf, LLC | Assisted Living Facility | 200 Poinciana Ave, Port Orange, FL 32127-6318 | 2015-03-18 |
| 1821406950 | Fran's Elderly Care Inc | Assisted Living Facility | 1309 Alcorn Rd, Port Orange, FL 32129-5242 | 2014-08-01 |
| 1801211339 | Manila Home Care Inc. | Assisted Living Facility | 799 Pheasant Run Ct, Port Orange, FL 32127-1131 | 2014-02-20 |
| 1801223854 | Coquina Cove Assisted Living | Assisted Living Facility | 3739 Sunrise Oaks Dr, Port Orange, FL 32129-8651 | 2013-10-07 |
| 1215362314 | Canalview Rest Home | Assisted Living Facility | 864 Canal View Blvd, Port Orange, FL 32129-4206 | 2013-09-07 |
| 1306180336 | Ancona Ltd., Inc. Dba Harbor Oaks Elderly Care Home | Assisted Living Facility | 158 Farmbrook Rd, Port Orange, FL 32127-6243 | 2012-11-15 |
| Find all providers in PORT ORANGE | ||||
| City | PORT ORANGE |
| Zip Code | 32127 |
Please comment or provide details below to improve the information on WICKSHIRE PORT ORANGE OPCO LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.