Provider Demographics
NPI:1073687448
Name:CUMBERLAND RIVER HOSPITAL INC
Entity Type:Organization
Organization Name:CUMBERLAND RIVER HOSPITAL INC
Other - Org Name:CUMBERLAND RIVER HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-243-3581
Mailing Address - Street 1:100 OLD JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TN
Mailing Address - Zip Code:38551-4040
Mailing Address - Country:US
Mailing Address - Phone:931-243-3581
Mailing Address - Fax:931-243-5219
Practice Address - Street 1:100 OLD JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551-4040
Practice Address - Country:US
Practice Address - Phone:931-243-3581
Practice Address - Fax:931-243-5219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN044S141Medicaid
IN100034800Medicaid
0713454OtherCIGNA
TNA3855100Medicaid
KYK65939910Medicaid
TN1000134OtherBCBS
TN5534Medicaid
TN0440141Medicaid
TN1000134Medicaid
TN4139416OtherNEW BC PROV #
TN4139416Medicaid
44M319Medicare Oscar/Certification
44M319Medicare PIN