WICKSHIRE CANTON OPCO LLC (NPI# 1619516093) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619516093 |
| Entity Type | Organization |
| Organization Name | WICKSHIRE CANTON OPCO LLC |
| Practice Address |
125 Riverstone Terrace Canton GA 30114 |
| Mailing Address |
750 Old Hickory Blvd Building One Suite 125 Brentwood TN 37027 |
| Practice Telephone | 7707209669 |
| Practice Fax Number | 6788803689 |
| Mailing Telephone | 6159420240 |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2020-01-02 |
| Authorized Official Name | MR. DANIEL OKEEFE (CEO) |
| Authorized Official Telephone | 6159420240 |
| Authorized Official Credential | JD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Street Address |
125 RIVERSTONE TERRACE |
| City | CANTON |
| State | GA |
| Zip Code | 30114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154803583 | Alixandra Nicole Flournoy | Physical Therapist | 131 Holly Street, Canton, GA 30114 | 2018-09-01 |
| 1588157341 | Provident Group - Canton Cove Properties LLC | Alzheimer Center (Dementia Center) | 1100 Reinhardt College Parkway, Canton, GA 30114 | 2018-06-07 |
| 1003233107 | Heartland Dental Care of Georgia | Dentist | 3237 Sixes Rd, Canton, GA 30114 | 2014-03-26 |
| 1730510959 | Joseph Optical | Eyewear Supplier (Equipment, not the service) | 1455 Riverstone Pkwy Suite 110, Canton, GA 30114 | 2013-12-13 |
| 1629313036 | Ramona Morton Rasmussen | Occupational Therapist | 200 Riverstone Drive, Suite B, Canton, GA 30114 | 2012-12-11 |
| 1902154875 | Yong Qiao Luo | Acupuncturist | 200 Oakside Lane, Suite D, Canton, GA 30114 | 2012-08-26 |
| 1215294350 | Christina Lynn Hernandez | Pediatrics | 1558 Riverstone Pkwy Ste 100, Canton, GA 30114 | 2012-04-13 |
| 1558638981 | Stephen E Byrd | Counselor | 191 Lamar Haley Pkwy., Canton, GA 30114 | 2011-11-30 |
| 1073807855 | Sheri Sullins Buckley | Nurse Practitioner | 120 Oakside Ct Ste H, Canton, GA 30114 | 2011-06-08 |
| 1326342098 | Eva Diane Martin | Counselor | 2920 Marietta Highway, Suite 146, Canton, GA 30114 | 2011-01-10 |
| Find all providers in zip 30114 | ||||
| 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 |
|---|---|---|---|---|
| 1871100412 | Forever Harmony PCh Inc | Assisted Living Facility | 205 Providence Walk Ct, Canton, GA 30114-8622 | 2020-09-28 |
| 1578118451 | Embrace Group Home LLC | Assisted Living Facility | 6934 N Canton Center Rd, Canton, MI 48187-1647 | 2019-08-07 |
| 1174093199 | Stone Crossing Skilled Care, LLC | Assisted Living Facility | 836 34th Street, Nw, Canton, OH 44709 | 2018-12-03 |
| 1831626266 | Stone Crossing Assisted Living, LLC | Assisted Living Facility | 820 34th St Nw, Canton, OH 44709-2966 | 2017-05-16 |
| 1922533736 | C&y Homes, Inc. | Assisted Living Facility | 3616 Rolling Ridge Rd Ne, Canton, OH 44721-3029 | 2017-04-30 |
| 1447662234 | Cornerstone At Canton Assisted Living LLC | Assisted Living Facility | 175 Revere Street, Canton, MA 02021 | 2014-05-28 |
| 1689901563 | Brookdale Senior Living Communities Inc | Assisted Living Facility | 1119 Perry Dr Nw, Canton, OH 44708-3374 | 2009-11-12 |
| 1164689766 | Ann Davis Rest Home | Assisted Living Facility | 460 Beaverdam St, Canton, NC 28716 | 2008-05-21 |
| 1932383973 | Petersen Health Care, Inc. | Assisted Living Facility | 160 East Walnut Street, Canton, IL 61520-2708 | 2007-12-27 |
| 1477749976 | Cathedral Assisted Living, LLC | Assisted Living Facility | 3927 38th St Nw, Canton, OH 44718 | 2007-09-18 |
| Find all providers in CANTON | ||||
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| 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.