Healthcare Provider Details

I. General information

NPI: 1710109822
Provider Name (Legal Business Name): THE CYPRESS CLUB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LADYSLIPPER LN
HILTON HEAD ISLAND SC
29926
US

IV. Provider business mailing address

20 LADYSLIPPER LN
HILTON HEAD ISLAND SC
29926-1372
US

V. Phone/Fax

Practice location:
  • Phone: 843-682-7116
  • Fax: 843-689-7084
Mailing address:
  • Phone: 843-682-7116
  • Fax: 843-689-7084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARC ANTHONY PUNTERERI
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 843-689-7007