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General NPI Number Information
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NPI Number | 1508122789
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Entity Type | Organization
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Legal Business Name | CYPRESS MANOR ASSISTED LIVING FACILITY INC.
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 7459 ROYAL PALM BLVD
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City | MARGATE
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State | FL
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Zip | 33063-1208
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Country | US
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Telephone | 954-979-6893
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Fax | 954-978-4594
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Provider Business Mailing Address
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Address Line | 7459 ROYAL PALM BLVD
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City | MARGATE
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State | FL
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Zip | 33063-1208
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Country | US
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Telephone | 954-979-6893
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Fax | 954-978-4594
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LURLINE MARIE EVANS
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Credential |
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Telephone | 954-292-0247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL9619
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License Number State | FL
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