Wickshire Fairborn Opco LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WICKSHIRE FAIRBORN OPCO LLC

Practice address

2270 Park Hills Drive
Fairborn, OH 45324

Phone

(937) 343-6208

Fax

(937) 754-9830

NPI assigned

Jan 2, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Daniel Okeefe, JD

Title

Ceo

Phone

(615) 942-0240

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1577923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577923200000",
    "number": "1982243382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 OLD HICKORY BLVD",
            "address_2": "BUILDING ONE SUITE 125",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "37027",
            "telephone_number": "615-942-0240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2270 PARK HILLS DRIVE",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "45324",
            "telephone_number": "937-343-6208",
            "fax_number": "937-754-9830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKSHIRE FAIRBORN OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-02",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A",
        "authorized_official_last_name": "OKEEFE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-942-0240",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany White
• Jade Whitney
• Angela Nichole Whitt, PTA
• Charles Robert Wick
• Heather Wicker
• Marie Wile
• Monique Lauren Wiley
• Darien E. Ramone Wilkerson, B.S
• Nicole Will
• Connie S Williams, LISW-SUPV

• Assisted Living Facility in Fairborn, OH
• Providers in Fairborn, OH by specialty
• Assisted Living Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; 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.