Organization
CYPRESS CREEK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACI WAGNER (OWNER)
(573) 351-1221
Entity
Organization
Contact information
Practice address
HC 1 BOX 313, FAIRDEALING, MO 63939-9710
(573) 351-1221
Mailing address
HC 1 BOX 313, FAIRDEALING, MO 63939-9710
(573) 351-1221
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
MO
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
MO
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
385H00000X
Respite Care
Primary
—
MO
Other
Enumeration date
03/28/2007
Last updated
09/11/2025
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