MEDICARE: CYPRESS PLACE, INC

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	310400000X	Assisted Living Facility	12513	FL

General Provider Information

NPI Number	:	1831597996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYPRESS PLACE, INC

Provider Business Mailing Address
First Line	:	9230 N CYPRESS CIR
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-2440
Country	:	US
Telephone Number	:	305-469-3482
Fax Number	:

Provider Business Practice Location Address
First Line	:	9230 N CYPRESS CIR
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-2440
Country	:	US
Telephone Number	:	305-469-3482
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LEONIE NELSON
Credential	:
Telephone Number	:	305-469-3482

Provider Enumeration Date	:	12/05/2014
Last Update Date	:	12/05/2014

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Directions to “CYPRESS PLACE, INC ” Practice Location

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