Provider Demographics
NPI:1780727081
Name:CYPRESS BASIN HOSPICE INC.
Entity type:Organization
Organization Name:CYPRESS BASIN HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-577-1510
Mailing Address - Street 1:PO BOX 544
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75456-0544
Mailing Address - Country:US
Mailing Address - Phone:903-577-1510
Mailing Address - Fax:903-577-9377
Practice Address - Street 1:207 MORGAN ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-5603
Practice Address - Country:US
Practice Address - Phone:903-577-1510
Practice Address - Fax:903-577-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002499251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002499OtherSTATE LICENSE NUMBER
TX000206500Medicaid