Healthcare Provider Details

I. General information

NPI: 1063655272
Provider Name (Legal Business Name): CYPRESS HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S PALESTINE ST
ATHENS TX
75751-2509
US

IV. Provider business mailing address

13110 W HWY 290 STE 103
AUSTIN TX
78737-8500
US

V. Phone/Fax

Practice location:
  • Phone: 903-675-2046
  • Fax: 903-675-2471
Mailing address:
  • Phone: 512-288-9123
  • Fax: 512-288-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number001-0170-22
License Number StateTX

VIII. Authorized Official

Name: MR. EMERY R. FISHER
Title or Position: PRES.
Credential:
Phone: 512-288-9119