Provider Demographics
NPI:1336121896
Name:THE CYPRESS CLUB, INC.
Entity Type:Organization
Organization Name:THE CYPRESS CLUB, INC.
Other - Org Name:PRESTON HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PUNTERERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-689-7007
Mailing Address - Street 1:20 LADYSLIPPER LN
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1372
Mailing Address - Country:US
Mailing Address - Phone:843-689-7000
Mailing Address - Fax:843-689-2653
Practice Address - Street 1:87 BIRDSONG WAY
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926
Practice Address - Country:US
Practice Address - Phone:843-689-7077
Practice Address - Fax:843-689-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF-0576314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC425325Medicare Oscar/Certification