Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Provident Group - Canton Cove Properties LLC

Organization Assisted Living Facility · NPI 1588157341

Provident Group - Canton Cove Properties LLC is an Assisted Living Facility in Canton, Georgia. Registered with an NPI since 2018.

In the registry since
2018
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1100 Reinhardt College Pkwy
Canton, GA 30114
Phone: (770) 721-2812
Fax: (770) 721-5701
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Assisted Living Facility (primary) Taxonomy 310400000X
Alzheimer Center (Dementia Center) Taxonomy 311500000X
Respite Care Taxonomy 385H00000X

Record details

NPI number1588157341
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Debra Lockwood — President & Chief Financial Officer · (225) 766-3977
Other names Provident Village At Canton
NPI enumeratedJune 7, 2018
Last updated in NPPESJune 7, 2018
Mailing address5565 Bankers Avenue, Baton Rouge, LA 70808

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