Provider Demographics
NPI:1770258675
Name:WICKSHIRE FORT LAUDERDALE OPCO LLC
Entity Type:Organization
Organization Name:WICKSHIRE FORT LAUDERDALE OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'KEEFE
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 1, 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 1:2855 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2973
Practice Address - Country:US
Practice Address - Phone:954-739-4200
Practice Address - Fax:954-739-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility