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WICKSHIRE PORT ORANGE OPCO LLC
NPI 1023616943
Assisted Living Facility in Port Orange, FL

Active since October 13, 2020CLIA 10D0990646 · Waiver
1675 DUNLAWTON AVE, PORT ORANGE, FL 32127(386) 761-1055 Get Directions Write a Review

NPPES record last updated: October 13, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Wickshire Port Orange Opco Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WICKSHIRE PORT ORANGE OPCO LLC (NPI 1023616943), doing business as Wickshire Port Orange, is a healthcare organization registered as an assisted living facility in Port Orange, Florida and active in the NPI registry since October 2020. The organization holds a CLIA Waiver certificate valid through August 27, 2027 and lists Dan O'keefe, Ceo, as its authorized official.

NPPES Registry Identity

NPI1023616943
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameWICKSHIRE PORT ORANGE OPCO LLC
Location Address1675 DUNLAWTON AVEPort Orange, FL 32127-4755
Mailing Address750 Old Hickory BlvdBrentwood, TN 37027-4528 · (615) 942-0240
Phone(386) 761-1055
Organization SubpartNo
Authorized OfficialDan O'keefeCeo · (615) 942-0240
Enumeration DateOctober 13, 2020
NPPES CertifiedOctober 13, 2020
✔ NPI 1023616943 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Also ListedAlzheimer Center (Dementia Center)Taxonomy 311500000X
1675 DUNLAWTON AVE, Port Orange, FL 32127
Open in Google Maps ↗

Other Names 1

Doing Business AsWickshire Port Orange

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D0990646

Wickshire Port Orange Fl Opco, LLC · Port Orange, FL
Active · expires Aug 27, 2027
CLIA Number10D0990646
Laboratory TypeAssisted Living Facility
Certificate Effective DateAugust 28, 2025
Certificate Expiration DateAugust 27, 2027
Laboratory DirectorMichelle Hanner
Laboratory Phone(386) 761-1055
Laboratory LocationWickshire Port Orange Fl Opco, LLC1675 Dunlawton Ave, Port Orange, FL 32127
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ERIC W HARTING PTA
Physical Therapy Assistant
1675 DUNLAWTON AVE
PORT ORANGE, FL 32127
Volusia County (386) 761-1055
MARGARET J. BOWS COTA
Occupational Therapy Assistant
1675 DUNLAWTON AVE
PORT ORANGE, FL 32127
Volusia County (386) 761-1055
TRACI L. FOX OT
Occupational Therapist
1675 DUNLAWTON AVE
PORT ORANGE, FL 32127
Volusia County (386) 761-1055
KELLY L ADAMS SLP
Speech-Language Pathologist
1675 DUNLAWTON AVE
PORT ORANGE, FL 32127
Volusia County (386) 761-1055
THERESA L HYATT PTA
Physical Therapy Assistant
1675 DUNLAWTON AVE
PORT ORANGE, FL 32127
Volusia County (386) 761-1055
ROBIN P EDSON PTA
Physical Therapy Assistant
1675 DUNLAWTON AVE
PORT ORANGE, FL 32127
Volusia County (386) 761-1055
LESLIE N COOK PTA
Physical Therapy Assistant
1675 DUNLAWTON AVE
PORT ORANGE, FL 32127
Volusia County (386) 761-1055
YVONNE J THOMPSON PTA
Physical Therapy Assistant
1675 DUNLAWTON AVE
PORT ORANGE, FL 32127
Volusia County (386) 761-1055

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wickshire Port Orange Opco LLC's NPI number?

The NPI number for Wickshire Port Orange Opco LLC is 1023616943. It was assigned to this organization in the NPPES registry on October 13, 2020.

Where is Wickshire Port Orange Opco LLC located?

Wickshire Port Orange Opco LLC is located at 1675 Dunlawton Ave, Port Orange, FL 32127. The listed phone number is (386) 761-1055.

What is Wickshire Port Orange Opco LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Wickshire Port Orange Opco LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D0990646) is associated with this NPI, valid through August 27, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Wickshire Port Orange Opco LLC was last updated on October 13, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.