Active NPI
CCRC Opco - Cypress Village, LLC
- Skilled Nursing Facility
- Jacksonville, FL
National Provider Identifier
1760431399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- SNF11170961
- Legal business name
- CCRC OPCO - CYPRESS VILLAGE, LLC
- Practice address
- 4600 Middleton Park Cir E
Jacksonville, FL 32224-5691 - Phone
- (901) 223-6100
- NPI assigned
- May 10, 2006
- Organization subpart
- Yes
- Parent organization
- BROOKDALE SENIOR LIVING INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Mark W Ohlendorf
- Title
- President
- Phone
- (414) 918-5000
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | AL7720 | FL | |
| Skilled Nursing Facility | 314000000X | SNF11170961 | FL | Primary |
Addresses
Primary practice location
4600 Middleton Park Cir E
Jacksonville, FL 32224-5691
Mailing address
330 N Wabash Ave
Suite 1400
Chicago, IL 60611-3586
Phone (312) 977-3700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30799800 | Medicaid | FL |
Other names 1
- Cypress Village
National Provider Directory
National Provider Directory- Tax ID family
- BLC Cypress Village LLC
- Part of
- Brookdale Senior Living Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Jacksonville, FL
- NPI 1790199057
Locations
330 N Wabash Ave
Ste 1400
Chicago, IL 60611
Phone (312) 977-3700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1412294400000",
"number": "1760431399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 N WABASH AVE",
"address_2": "SUITE 1400",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113586",
"telephone_number": "312-977-3700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4600 MIDDLETON PARK CIR E",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322245691",
"telephone_number": "901-223-6100"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CCRC OPCO - CYPRESS VILLAGE, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BROOKDALE SENIOR LIVING INC",
"enumeration_date": "2006-05-10",
"last_updated": "2014-10-03",
"status": "A",
"authorized_official_last_name": "OHLENDORF",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "W",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "414-918-5000",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "FL",
"license": "AL7720",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "FL",
"license": "SNF11170961",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30799800",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Cypress Village",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.