Provider Demographics
NPI:1437410107
Name:CUMBERLAND RIDGE ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:CUMBERLAND RIDGE ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JINGER
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:LOGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:931-456-8688
Mailing Address - Street 1:458 WAYNE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-9220
Mailing Address - Country:US
Mailing Address - Phone:931-456-8666
Mailing Address - Fax:931-456-2355
Practice Address - Street 1:458 WAYNE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-9220
Practice Address - Country:US
Practice Address - Phone:931-456-8666
Practice Address - Fax:931-456-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNH445619310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445619Medicaid