Wickshire Countryside Opco LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WICKSHIRE COUNTRYSIDE OPCO LLC

Practice address

3141 N McMullen Booth Rd
Clearwater, FL 33761-2035

Phone

(727) 723-7110

NPI assigned

Oct 13, 2020

Organization subpart

No

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

Authorized official

Name

Dan O'Keefe

Title

Ceo

Phone

(615) 942-0240

Specialties & licenses 2

Addresses

Other names 1

• Wickshire Countryside Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1750989687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 OLD HICKORY BLVD",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370274528",
            "telephone_number": "615-942-0240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3141 N MCMULLEN BOOTH RD",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337612035",
            "telephone_number": "727-723-7110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKSHIRE COUNTRYSIDE OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-13",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "O'KEEFE",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-942-0240"
    },
    "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
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wickshire Countryside",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael L. Whitworth, M.D.
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• Whole Life Home Health LLC
• George Wickramanayake
• Kay B Widmer-Hren, PT
• Janice Wiggins, B.A.
• Ladarius Markel Wilcox
• Dennis Emery Wilcoxon, O.D.
• Terrance Wilder, OTR/L

• Assisted Living Facility in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.