Provider Demographics
NPI:1003481086
Name:CAPSTONE-CYPRESS OPCO LLC
Entity Type:Organization
Organization Name:CAPSTONE-CYPRESS OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-712-6025
Mailing Address - Street 1:100 W DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75657-1206
Mailing Address - Country:US
Mailing Address - Phone:903-665-9855
Mailing Address - Fax:903-665-6809
Practice Address - Street 1:100 W DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:TX
Practice Address - Zip Code:75657-1206
Practice Address - Country:US
Practice Address - Phone:903-665-9855
Practice Address - Fax:903-665-6809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility