1821091851 NPI number — CUMBERLAND COUNTY HOSPITAL SYSTEM, INC

Table of content: (NPI 1821091851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821091851 NPI number — CUMBERLAND COUNTY HOSPITAL SYSTEM, INC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
CUMBERLAND COUNTY HOSPITAL SYSTEM, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHEASTERN REGIONAL REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821091851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1638 OWEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28304-3424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-609-6440
Provider Business Mailing Address Fax Number:
910-609-5365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1638 OWEN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28304-3424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-609-6440
Provider Business Practice Location Address Fax Number:
910-609-5365
Provider Enumeration Date:
05/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PARKS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
910-609-6700

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , with the licence number:  H0213 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3400028T , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".