Provider Demographics
NPI:1780639054
Name:CYPRESS MANOR HEALTH CARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CYPRESS MANOR HEALTH CARE ASSOCIATES, LLC
Other - Org Name:CYPRESS COMMUNITY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTH. REPRESENTATIVE/EXEC. DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLLMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-936-0203
Mailing Address - Street 1:7173 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2938
Mailing Address - Country:US
Mailing Address - Phone:239-936-0203
Mailing Address - Fax:239-936-9544
Practice Address - Street 1:7173 CYPRESS DR
Practice Address - Street 2:
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2938
Practice Address - Country:US
Practice Address - Phone:239-936-0203
Practice Address - Fax:239-936-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF11160961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
105427Medicare ID - Type Unspecified