1891471256 NPI number — CUMBERLAND CREEK ASSISTED LIVING INC.

Table of content: MIRANDA ARRINGTON PT, DPT (NPI 1982420923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891471256 NPI number — CUMBERLAND CREEK ASSISTED LIVING INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUMBERLAND CREEK ASSISTED LIVING 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:
Provider Other Organization Name Type Code:
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:
1891471256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4749 US HIGHWAY 701 BUS S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28433-9758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-862-3693
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1124 CEDAR CREEK RD
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:
28312-6544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-323-8212
Provider Business Practice Location Address Fax Number:
910-485-0890
Provider Enumeration Date:
06/22/2023

Additional Information

Authorized Official

Authorized Official Last Name:
CLIFTON
Authorized Official First Name:
MARY-MARGARET
Authorized Official Middle Name:
LENNON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-874-4226

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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