Healthcare Provider Details

I. General information

NPI: 1346223765
Provider Name (Legal Business Name): CYPRESS AT LAKE PROVIDENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 09/02/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5976 HIGHWAY 65 N
LAKE PROVIDENCE LA
71254-5235
US

IV. Provider business mailing address

10401 LINN STATION RD STE 300
LOUISVILLE KY
40223-3825
US

V. Phone/Fax

Practice location:
  • Phone: 318-559-2248
  • Fax: 318-559-3381
Mailing address:
  • Phone: 270-336-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number304
License Number StateLA

VIII. Authorized Official

Name: DONALD J. KNOX
Title or Position: CEO
Credential:
Phone: 740-359-5401