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Organization
PROVIDENT GROUP - CANTON COVE PROPERTIES LLC
Active
Organization
PROVIDENT GROUP - CANTON COVE PROPERTIES LLC
Active
Other names
Provident Village at Canton
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA W. LOCKWOOD (PRESIDENT & CHIEF FINANCIAL OFFICER)
(225) 766-3977
Entity
Organization
Contact information
Practice address
1100 REINHARDT COLLEGE PARKWAY, CANTON, GA 30114
(770) 721-2812
(770) 721-5701
Mailing address
5565 BANKERS AVENUE, BATON ROUGE, LA 70808
(225) 766-3977
(225) 766-3988
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
311500000X
Alzheimer Center (Dementia Center)
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
06/07/2018
Last updated
06/07/2018
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