| NPI | 1023616943 |
|---|---|
| Doing Business As | WICKSHIRE PORT ORANGE |
| Entity Type | Organization |
| Authorized Contact | DAN O'KEEFE CEO 615-942-0240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 311500000X Alzheimer Center (Dementia Center) |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2020-10-13 |