Provider Demographics
NPI:1063613016
Name:CYPRESS INN ASSISTED LIVING CENTER
Entity type:Organization
Organization Name:CYPRESS INN ASSISTED LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMERITA
Authorized Official - Middle Name:
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-364-7232
Mailing Address - Street 1:757 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-1934
Mailing Address - Country:US
Mailing Address - Phone:520-364-7232
Mailing Address - Fax:520-364-5322
Practice Address - Street 1:757 E 12TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-1934
Practice Address - Country:US
Practice Address - Phone:520-364-7232
Practice Address - Fax:520-364-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ709719OtherAHCCCS