Wickshire Port St. Lucie
Assisted Living Facility in Port St Lucie, FL. Organization (NPI-2).
NPI number1184222002
StatusActive
Last updated in NPPESOct 13, 2020
Details
- NPI
- 1184222002
- Entity type
- Organization (NPI-2)
- Legal business name
- Wickshire Port St. Lucie
- Organization subpart
- No
- Enumeration date
- Oct 13, 2020
- Certification date
- Oct 13, 2020
- Last updated
- Oct 13, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 310400000X | Assisted Living Facility | – | – | Yes |
| 311500000X | Alzheimer Center (Dementia Center) | – | – |
Other names
- Wickshire Port St Lucie (Doing Business As)
Practice location
9825 S Us Highway 1Port St Lucie, FL 34952-5626
Phone 772-337-0084
Mailing address
750 Old Hickory BlvdBrentwood, TN 37027-4528
Phone 615-942-0240
Authorized official
Dan O'Keefe
Ceo
6159420240
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