PROVIDENT VILLAGE AT CANTON
NPI 1588157341
Assisted Living Facility in Canton, GA

Q: What is Provident Group - Canton Cove Properties LLC's specialty?

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

Active since June 07, 2018

1100 REINHARDT COLLEGE PARKWAY, CANTON, GA 30114(770) 721-2812(770) 721-5701 Get Directions Write a Review

NPPES record last updated: June 7, 2018. Verified against the NPPES registry weekly; last sync: October 04, 2026.

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About Provident Village At Canton NPPES

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

PROVIDENT VILLAGE AT CANTON (NPI 1588157341) is a healthcare organization registered as an assisted living facility in Canton, Georgia and active in the NPI registry since June 2018. The organization lists Debra W. Lockwood, President & Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1588157341

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NamePROVIDENT GROUP - CANTON COVE PROPERTIES LLC

Location Address1100 REINHARDT COLLEGE PARKWAYCanton, GA 30114

Mailing Address5565 Bankers AvenueBaton Rouge, LA 70808 · (225) 766-3977 · Fax (225) 766-3988

Phone(770) 721-2812

Fax(770) 721-5701

Organization SubpartNo

Authorized OfficialDebra W. LockwoodPresident & Chief Financial Officer · (225) 766-3977

Enumeration DateJune 7, 2018

✔ NPI 1588157341 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ 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

Also ListedRespite CareTaxonomy 385H00000X

1100 REINHARDT COLLEGE PARKWAY, Canton, GA 30114

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Other Names 1

Doing Business AsProvident Village At Canton

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 Provident Group - Canton Cove Properties LLC's NPI number?

The NPI number for Provident Group - Canton Cove Properties LLC is 1588157341. It was assigned to this organization in the NPPES registry on June 7, 2018. The provider is doing business as Provident Village At Canton.

Where is Provident Group - Canton Cove Properties LLC located?

Provident Group - Canton Cove Properties LLC is located at 1100 Reinhardt College Parkway, Canton, GA 30114. The listed phone number is (770) 721-2812.

What is Provident Group - Canton Cove Properties LLC's specialty?

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

When was this NPI record last updated?

The NPPES record for Provident Group - Canton Cove Properties LLC was last updated on June 7, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.