NPIMap

Organization Active NPI

Cypress Cove at Health Park of Florida, Inc.

  • Skilled Nursing Facility
  • Fort Myers, FL
National Provider Identifier
1992748628
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
SNF130471008 Issued in FL
Legal business name
CYPRESS COVE AT HEALTH PARK OF FLORIDA, INC.
Practice address
10500 Cypress Cove Dr
Fort Myers, FL 33908-6692
Phone
(239) 415-5100
Fax
(239) 415-1840
NPI assigned
Jun 13, 2006
Last updated
Sep 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Authorized official

Name
Mr. Troy Churchill
Title
Ceo and President
Phone
(239) 415-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X SNF130471008 FL Primary

Addresses

Primary practice location

10500 Cypress Cove Dr
Fort Myers, FL 33908-6692

Mailing address

10200 Cypress Cove Dr
Fort Myers, FL 33908-6690
Phone (239) 415-5100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120611000291 FL Part A Provider - Skilled Nursing Facility 4284537010 Practice locations: Fort Myers, FL
O20140819001276 FL Part B Supplier - Clinic/Group Practice 2860619632 Receives reassigned benefits from 588 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992748628. Details of each certification follow.

Skilled nursing facility certification: CCN 106019

Legal name
CYPRESS COVE AT HEALTH PARK OF FLORIDA, INC.
Doing business as
THE LODGE AT CYPRESS COVE
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Apr 26, 2000
Last certification
Jan 18, 2024
Beds
64
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 3, 1995 in FL
Enrollment address
10500 Cypress Cove Dr
Fort Myers, FL 33908-6692
Nursing home name
LODGE AT CYPRESS COVE, THE

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lodge at Cypress Cove, theCCN 106019 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare
Ownership
Non profit - Corporation
Certified
Apr 26, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6452.8 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0967434Cypress Cove Health Park10500 Cypress Cove Dr, Fort Myers, FL 33908Certificate of waiverNov 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Dna Comprehensive Therapy S70 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

3157 N Alafaya Trl
Orlando, FL 32826
Phone (407) 215-0095

8839 Bryan Dairy Rd
Ste 310
Seminole, FL 33777
Phone (727) 446-5681

5825 Argerian Dr
Ste 101
Wesley Chapel, FL 33545
Phone (813) 687-4870

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Charity Buist Individual Corporate DirectorVP of Finance Mar 24, 2025
Adp of the SNF Mar 24, 2025
Jimmy C Liu Individual Operational/Managerial Control Feb 9, 2024
Adp of the SNF Nov 21, 2025
Mary E Franklin Individual Corporate DirectorExecutive Director Jan 26, 2020 100%
Operational/Managerial Control Jan 26, 2020
Lee Memorial Hospital Inc Organization, Fort Myers, FL Non-profit 5% Or Greater Direct Ownership Interest Apr 26, 2000 100%
Tily Sayeh Individual Corporate DirectorAdministrator May 12, 2024 100%
Adp of the SNF Feb 3, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

Affiliated clinicians 11

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1992748628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10200 CYPRESS COVE DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339086690",
            "telephone_number": "239-415-5100",
            "fax_number": "239-415-1840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10500 CYPRESS COVE DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339086692",
            "telephone_number": "239-415-5100",
            "fax_number": "239-415-1840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CYPRESS COVE AT HEALTH PARK OF FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A",
        "authorized_official_last_name": "CHURCHILL",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "CEO AND PRESIDENT",
        "authorized_official_telephone_number": "239-415-5100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF130471008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.