Healthcare Provider Details

I. General information

NPI: 1215510458
Provider Name (Legal Business Name): WICKSHIRE NORMAN OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 RAMBLING OAKS DRIVE
NORMAN OK
73072
US

IV. Provider business mailing address

750 OLD HICKORY BLVD BUILDING ONE SUITE 125
BRENTWOOD TN
37027
US

V. Phone/Fax

Practice location:
  • Phone: 405-942-0240
  • Fax:
Mailing address:
  • Phone: 615-942-0240
  • Fax: 615-806-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAN O'KEEFE
Title or Position: CEO
Credential:
Phone: 615-942-0240