Provider Demographics
NPI:1427253814
Name:THE CYPRESS CLUB, INC.
Entity type:Organization
Organization Name:THE CYPRESS CLUB, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:843-689-7017
Mailing Address - Fax:843-689-7084
Practice Address - Street 1:20 LADYSLIPPER LN
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:843-689-7017
Practice Address - Fax:843-689-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA-0146251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherEMPLOYER ID NUMBER