Organization Active NPI

Cypress Place Living Center, LLC

  • Intellectual Disabilities Intermediate Care Facility
  • Wetumka, OK
National Provider Identifier
1215019195
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
NH3212-3212 Issued in OK
Legal business name
CYPRESS PLACE LIVING CENTER, LLC
Practice address
204 E 1St St
Wetumka, OK 74883-6041
Phone
(405) 452-3271
Fax
(405) 452-5154
NPI assigned
Oct 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Donna R Simmons
Title
Office Manager
Phone
(405) 786-2266

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X NH3212-3212 OK Primary

Addresses

Primary practice location

204 E 1St St
Wetumka, OK 74883-6041

Mailing address

PO Box 488
Weleetka, OK 74880-0488
Phone (405) 786-2266

Other names 1

  • Adkins, LP dba Cypress Place Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215019195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 488",
            "city": "WELEETKA",
            "state": "OK",
            "postal_code": "748800488",
            "telephone_number": "405-786-2266",
            "fax_number": "405-786-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 E 1ST ST",
            "city": "WETUMKA",
            "state": "OK",
            "postal_code": "748836041",
            "telephone_number": "405-452-3271",
            "fax_number": "405-452-5154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CYPRESS PLACE LIVING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "405-786-2266",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OK",
            "license": "NH3212-3212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adkins, LP dba Cypress Place",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Wetumka, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.