WICKSHIRE COUNTRYSIDE OPCO LLC NPI 1750989687

NPI Information

WICKSHIRE COUNTRYSIDE OPCO LLC is an assisted living facility in Clearwater, FL. The provider is 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. WICKSHIRE COUNTRYSIDE OPCO LLC NPI is 1750989687. The provider is registered as an organization entity type.

The provider's business location address is:

3141 N MCMULLEN BOOTH RD
CLEARWATER, FL
ZIP 33761-035
Phone: (727) 723-7110

The provider's authorized official is Dan O'keefe .
The authorized official title is Ceo and has the following contact phone number (615) 942-0240.

The CLIA number assigned to this NPI record is 10D2209190 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/13/2020 and was last updated on 10/13/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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