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Cypress Creek Residential Care LLC

Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Fairdealing, MO

NPI 1366564676 · NPPES record last updated Oct 17, 2024

Key facts

NPI
1366564676
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
Legal business name
CYPRESS CREEK RESIDENTIAL CARE LLC
Practice address
546 Ripley BB-1
Fairdealing, MO 63939-8003
Phone
(573) 351-1221
NPI assigned
Apr 6, 2007
Organization subpart
No

Authorized official

Name
Ms. Traci Wagner
Title
Owner
Phone
(573) 351-1221

Corporate family (same tax ID) 2

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Cypress Creek LLC (3 organizations share this tax ID)

Locations

546 Ripley Bb-1
Fairdealing, MO 63939
Phone (573) 351-1221

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X MO
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X MO Yes
Respite Care 385H00000X MO

Addresses

Primary practice location

546 Ripley BB-1
Fairdealing, MO 63939-8003

Mailing address

546 Ripley BB-1
Fairdealing, MO 63939-8003
Phone (573) 351-1221

Other identifiers

IdentifierTypeStateIssuer
853295210MedicaidMO

Other providers in Fairdealing, MO

All providers in Fairdealing, MO · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri

Sources for this page

Verify at the official NPI Registry.