Basic Information
| Provider Information | |||||||||
| NPI: | 1902023526 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CUMBERLAND RIVER BEHAVIORAL HEALTH, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CUMBERLAND RIVER COMPREHENSIVE CARE CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 568 | ||||||||
| Address2: | |||||||||
| City: | CORBIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407020568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065287010 | ||||||||
| FaxNumber: | 6065285401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1203 AMERICAN GREETING RD | ||||||||
| Address2: | |||||||||
| City: | CORBIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407014811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065287010 | ||||||||
| FaxNumber: | 6065285401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 08/19/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | YEAGER | ||||||||
| AuthorizedOfficialFirstName: | MELANIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6065287010 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | N | Ambulatory Health Care Facilities | Clinic/Center | Health Service | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 251C00000X | N | Agencies | Day Training, Developmentally Disabled Services | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 45305554 | 05 | KY | MEDICAID | 33900051 | 05 | KY | MEDICAID | 17000696 | 05 | KY | MEDICAID | 30613038 | 05 | KY | MEDICAID | 27013010 | 05 | KY | MEDICAID | 28013019 | 05 | KY | MEDICAID |