Provident Group - Canton Cove Properties LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PROVIDENT GROUP - CANTON COVE PROPERTIES LLC

Doing business as

Provident Village at Canton

Practice address

1100 Reinhardt College Parkway
Canton, GA 30114

Phone

(770) 721-2812

Fax

(770) 721-5701

NPI assigned

Jun 7, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debra W. Lockwood

Title

President & Chief Financial Officer

Phone

(225) 766-3977

Specialties & licenses 3

Addresses

Other names 1

• Provident Village at Canton Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528329600000",
    "number": "1588157341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5565 BANKERS AVENUE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70808",
            "telephone_number": "225-766-3977",
            "fax_number": "225-766-3988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 REINHARDT COLLEGE PARKWAY",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "30114",
            "telephone_number": "770-721-2812",
            "fax_number": "770-721-5701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT GROUP - CANTON COVE PROPERTIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-07",
        "last_updated": "2018-06-07",
        "status": "A",
        "authorized_official_last_name": "LOCKWOOD",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "225-766-3977"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provident Village at Canton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Canton, GA
• Providers in Canton, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.