Healthcare Provider Details

I. General information

NPI: 1871540005
Provider Name (Legal Business Name): CYPRESS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 POPLAR ST
HANCOCK MI
49930-1121
US

IV. Provider business mailing address

1400 POPLAR ST
HANCOCK MI
49930-1121
US

V. Phone/Fax

Practice location:
  • Phone: 906-482-6644
  • Fax: 906-482-0983
Mailing address:
  • Phone: 906-482-6644
  • Fax: 906-482-0983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number314020
License Number StateMI

VIII. Authorized Official

Name: AARON MAUER
Title or Position: CFO
Credential:
Phone: 847-902-9586