# CYPRESS GLEN RETIREMENT COMMUNITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053395335
- **Authorized official:** MR. DONALD E. METZGER SR. (CHAIRMAN OF THE BOARD)
- **Authorized official phone:** (910) 738-4652

## Contact information

- **Practice address:** 100 HICKORY STREET, GREENVILLE, NC 27585-1637
- **Practice address phone:** (252) 830-0036
- **Practice address fax:** (252) 830-0411
- **Mailing address:** 100 HICKORY STREET, GREENVILLE, NC 27585-1637
- **Mailing address phone:** (252) 830-0036
- **Mailing address fax:** (252) 830-0411

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH0473 | NC | Yes |

## Other

- **Enumeration date:** 12/01/2005
- **Last updated:** 08/11/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 009CH | BLIE CROSS AND BLUE SHILE | NC |