1902883184 NPI number — CYPRESS HOME CARE, INC.

Table of content: (NPI 1902883184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902883184 NPI number — CYPRESS HOME CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYPRESS HOME CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902883184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2284
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75456-2284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-575-9506
Provider Business Mailing Address Fax Number:
903-577-8111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 W 1ST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT. PLEASANT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-577-0577
Provider Business Practice Location Address Fax Number:
903-577-8111
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
JOY
Authorized Official Title or Position:
VP OF COMPLIANCE/ADMINISTRATOR
Authorized Official Telephone Number:
903-577-0577

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  004392 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 025127401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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