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General NPI Number Information
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NPI Number | 1346223765
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Entity Type | Organization
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Legal Business Name | CYPRESS AT LAKE PROVIDENCE, LLC
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 5976 HIGHWAY 65 N
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City | LAKE PROVIDENCE
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State | LA
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Zip | 71254-5235
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Country | US
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Telephone | 318-559-2248
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Fax | 318-559-3381
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Provider Business Mailing Address
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Address Line | 10401 LINN STATION RD STE 300
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City | LOUISVILLE
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State | KY
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Zip | 40223-3825
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Country | US
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Telephone | 270-336-1050
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DONALD J. KNOX
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Credential |
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Telephone | 740-359-5401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 304
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License Number State | LA
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