NPI 1790150308

Cypress Place Re 2015, LLC

Organisation Assisted Living Facility Jefferson, TX

Practice location

Address: 100 W Douglas St, Jefferson, TX 75657-1206
Phone: (903) 665-9855
Mailing address: 3973 W Vickery Blvd Suite 101, Fort Worth, TX 76107-6492

Authorised official

Name: Lawrence Wayne Powell
Title: President
Phone: (817) 386-8888

Registered specialties

Assisted Living Facility Primary

Nursing & Custodial Care Facilities Taxonomy 310400000X

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Registry record

NPI: 1790150308
Entity type: Organization
NPI issued: 8 Dec 2015
Record last updated: 8 Dec 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.