Basic Information
| Provider Information | |||||||||
| NPI: | 1497125223 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CUMBERLAND HOSPITAL, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CUMBERLAND SEGER HOUSE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9407 CUMBERLAND RD | ||||||||
| Address2: | |||||||||
| City: | NEW KENT | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231242029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8049662242 | ||||||||
| FaxNumber: | 8049661643 | ||||||||
| Practice Location | |||||||||
| Address1: | 3627 CAROLINA AVE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232222910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042283501 | ||||||||
| FaxNumber: | 8042283504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2015 | ||||||||
| LastUpdateDate: | 10/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | BROOKS | ||||||||
| AuthorizedOfficialFirstName: | PATRICE | ||||||||
| AuthorizedOfficialMiddleName: | GAY | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8049662242 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CUMBERLAND HOSPITAL, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | 549-14-005 | VA | Y | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
No ID Information.