Provider Demographics
NPI:1013945435
Name:CYPRESS DALLAS LP
Entity Type:Organization
Organization Name:CYPRESS DALLAS LP
Other - Org Name:BROOKDALE THERAPY TOWN VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CAO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-2250
Mailing Address - Street 1:111 WESTWOOD PLACE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5707
Mailing Address - Country:US
Mailing Address - Phone:615-221-2250
Mailing Address - Fax:
Practice Address - Street 1:12271 COIT RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2300
Practice Address - Country:US
Practice Address - Phone:214-438-4904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE SENIOR LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-28
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676653Medicare Oscar/Certification