Provider Demographics
NPI:1902883184
Name:CYPRESS HOME CARE, INC.
Entity Type:Organization
Organization Name:CYPRESS HOME CARE, INC.
Other - Org Name:CYPRESS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF COMPLIANCE/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-577-0577
Mailing Address - Street 1:PO BOX 2284
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75456-2284
Mailing Address - Country:US
Mailing Address - Phone:903-575-9506
Mailing Address - Fax:903-577-8111
Practice Address - Street 1:303 W 1ST STREET
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455
Practice Address - Country:US
Practice Address - Phone:903-577-0577
Practice Address - Fax:903-577-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004392251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX025127401Medicaid
TX025127401Medicaid