Provider Demographics
NPI:1336143023
Name:CUMBERLAND COUNTY
Entity Type:Organization
Organization Name:CUMBERLAND COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-503-2913
Mailing Address - Street 1:1 COURT HOUSE SQ
Mailing Address - Street 2:RM 207
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3323
Mailing Address - Country:US
Mailing Address - Phone:717-243-2031
Mailing Address - Fax:717-240-1952
Practice Address - Street 1:1000 CLAREMONT RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-7310
Practice Address - Country:US
Practice Address - Phone:717-243-2031
Practice Address - Fax:717-240-1952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA037602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000073090009Medicaid
PA1000073090009Medicaid