Provider Demographics
NPI:1992748628
Name:CYPRESS COVE AT HEALTH PARK OF FLORIDA, INC.
Entity type:Organization
Organization Name:CYPRESS COVE AT HEALTH PARK OF FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-415-5100
Mailing Address - Street 1:10200 CYPRESS COVE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-6690
Mailing Address - Country:US
Mailing Address - Phone:239-415-5100
Mailing Address - Fax:239-415-1840
Practice Address - Street 1:10500 CYPRESS COVE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-6692
Practice Address - Country:US
Practice Address - Phone:239-415-5100
Practice Address - Fax:239-415-1840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF130471008314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106019Medicare Oscar/Certification