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NPI Code Detail

MEDICARE: CCRC OPCO - CYPRESS VILLAGE, LLC

MEDICARE: CCRC OPCO - CYPRESS VILLAGE, 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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790199057
Entity Type Code : Organization
Provider Name (Legal Business Name) : CCRC OPCO - CYPRESS VILLAGE, LLC
Provider Business Mailing Address
First Line : 1920 MAIN ST STE 1200
Second Line :
City : IRVINE
State : CA
Zip : 92614-7230
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4600 MIDDLETON PARK CIR E
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-5691
Country : US
Telephone Number : 904-223-6100
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : STEPHANIE MARKOSKI
Credential :
Telephone Number : 904-223-6100
Provider Enumeration Date : 06/16/2014
Last Update Date : 01/19/2026

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Directions to “CCRC OPCO - CYPRESS VILLAGE, LLC ” Practice Location

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