Basic Information
| Provider Information | |||||||||
| NPI: | 1588192132 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CYPRESSWOOD TX MANAGEMENT LLC | ||||||||
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| OtherOrganizationName: | TEXAS INSTITUTE FOR CLINICALLY COMPLEX CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1981 MARCUS AVE STE C129 | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165965222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10851 CRESCENT MOON DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770644020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819554100 | ||||||||
| FaxNumber: | 2819554188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2017 | ||||||||
| LastUpdateDate: | 05/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | FRIEDMAN | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5165965222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.