Provider Demographics
NPI:1619132024
Name:THE CYPRESS OF RALEIGH CLUB, INC.
Entity Type:Organization
Organization Name:THE CYPRESS OF RALEIGH CLUB, INC.
Other - Org Name:THE ROSEWOOD HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GABIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-518-8951
Mailing Address - Street 1:8801 CYPRESS LAKES DR.
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8710 CYPRESS CLUB DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615
Practice Address - Country:US
Practice Address - Phone:919-870-9007
Practice Address - Fax:919-518-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC345546314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC345546OtherMEDICARE PTAN
NCNH0622OtherNURSING FACILITY LICENSE