Provider Demographics
NPI:1063446938
Name:CUMBERLAND COUNTY
Entity Type:Organization
Organization Name:CUMBERLAND COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:HANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-849-3211
Mailing Address - Street 1:P.O. BOX 130
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:IL
Mailing Address - Zip Code:62468-0130
Mailing Address - Country:US
Mailing Address - Phone:217-849-3211
Mailing Address - Fax:217-849-3121
Practice Address - Street 1:200 S. INDIANA ST.
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IL
Practice Address - Zip Code:62468-0130
Practice Address - Country:US
Practice Address - Phone:217-849-3211
Practice Address - Fax:217-849-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251K00000X
IL209005982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicare ID - Type Unspecified
IL331560Medicare ID - Type Unspecified