Provider Demographics
NPI:1306358916
Name:CUMBERLAND REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:CUMBERLAND REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-400-0725
Mailing Address - Street 1:1227 N WASHINGTON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1837
Mailing Address - Country:US
Mailing Address - Phone:931-400-0725
Mailing Address - Fax:931-400-0726
Practice Address - Street 1:1227 N WASHINGTON AVE STE 106
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1837
Practice Address - Country:US
Practice Address - Phone:931-400-0725
Practice Address - Fax:931-400-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-05
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ032252Medicaid