Healthcare Provider Details

I. General information

NPI: 1568584050
Provider Name (Legal Business Name): CYPRESS LANDING FAMILY CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 CULLEN RD
HARRELLSVILLE NC
27942-9766
US

IV. Provider business mailing address

622 CULLEN RD
HARRELLSVILLE NC
27942-9766
US

V. Phone/Fax

Practice location:
  • Phone: 252-356-2260
  • Fax: 252-356-2260
Mailing address:
  • Phone: 252-356-2260
  • Fax: 252-356-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL-046-017
License Number StateNC

VIII. Authorized Official

Name: MRS. MABLE P WHITE
Title or Position: ADMINISTRATOR
Credential:
Phone: 252-356-2260