Provider Demographics
NPI:1982025920
Name:CHESTNUT RIDGE CYPRESS LLC
Entity Type:Organization
Organization Name:CHESTNUT RIDGE CYPRESS LLC
Other - Org Name:CHESTNUT RIDGE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:Y
Authorized Official - Last Name:OVITS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-694-6055
Mailing Address - Street 1:125 SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2354
Mailing Address - Country:US
Mailing Address - Phone:770-889-0120
Mailing Address - Fax:
Practice Address - Street 1:125 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2354
Practice Address - Country:US
Practice Address - Phone:770-889-0120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CYPRESS SKILLED NURSING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-18
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA115423Medicare Oscar/Certification