Provider Demographics
NPI:1467091868
Name:WICKSHIRE DEER PARK OPCO LLC
Entity Type:Organization
Organization Name:WICKSHIRE DEER PARK OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OKEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:615-942-0240
Mailing Address - Street 1:750 OLD HICKORY BLVD
Mailing Address - Street 2:BUILDING ONE SUITE 125
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-942-0240
Mailing Address - Fax:
Practice Address - Street 1:3801 EAST GALBRAITH ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236
Practice Address - Country:US
Practice Address - Phone:513-443-6224
Practice Address - Fax:513-745-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility