Provider Demographics
NPI:1982641072
Name:CYPRESS SQUARE HEALTH CARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CYPRESS SQUARE HEALTH CARE ASSOCIATES, LLC
Other - Org Name:CYPRESS SQUARE VILLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BATTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-278-0136
Mailing Address - Street 1:7205 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2975
Mailing Address - Country:US
Mailing Address - Phone:239-278-0136
Mailing Address - Fax:239-278-3038
Practice Address - Street 1:7205 CYPRESS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2975
Practice Address - Country:US
Practice Address - Phone:239-278-0136
Practice Address - Fax:239-278-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7262310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility