MEDICARE: CYPRESS COVE LESSEE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1275764961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYPRESS COVE LESSEE LLC

Provider Business Mailing Address
First Line	:	611 COMMERCE ST
Second Line	:	SUITE 3125
City	:	NASHVILLE
State	:	TN
Zip	:	37203-3742
Country	:	US
Telephone Number	:	615-255-0009
Fax Number	:	615-242-1822

Provider Business Practice Location Address
First Line	:	700 SE 8TH AVE
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-4855
Country	:	US
Telephone Number	:	352-795-8832
Fax Number	:	352-795-0490

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES P. EARLE III
Credential	:
Telephone Number	:	615-255-0009

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	07/29/2009

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Directions to “CYPRESS COVE LESSEE LLC ” Practice Location

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