MEDICARE: CYPRESS CREEK ASSISTED LIVING RESIDENCE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311500000X	Alzheimer Center (Dementia Center)	AL9553	FL
2	310400000X	Assisted Living Facility	AL9553	FL

General Provider Information

NPI Number	:	1811324478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYPRESS CREEK ASSISTED LIVING RESIDENCE INC

Provider Business Mailing Address
First Line	:	970 CYPRESS VILLAGE BLVD
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33573-6830
Country	:	US
Telephone Number	:	813-633-7777
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 CYPRESS VILLAGE BLVD
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33573-6830
Country	:	US
Telephone Number	:	813-633-7777
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES BIGGINS
Credential	:
Telephone Number	:	813-633-7777

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	09/27/2013

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