Provider Demographics
NPI:1831642933
Name:CYPRESS LAKE LODGE
Entity Type:Organization
Organization Name:CYPRESS LAKE LODGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-568-1210
Mailing Address - Street 1:1129 US HIGHWAY 287
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-3722
Mailing Address - Country:US
Mailing Address - Phone:281-384-7815
Mailing Address - Fax:713-527-8558
Practice Address - Street 1:1129 US HIGHWAY 287
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-3722
Practice Address - Country:US
Practice Address - Phone:281-384-7815
Practice Address - Fax:713-527-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility