Provider Demographics
NPI:1497125223
Name:CUMBERLAND HOSPITAL, LLC
Entity Type:Organization
Organization Name:CUMBERLAND HOSPITAL, LLC
Other - Org Name:CUMBERLAND SEGER HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-966-2242
Mailing Address - Street 1:9407 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENT
Mailing Address - State:VA
Mailing Address - Zip Code:23124-2029
Mailing Address - Country:US
Mailing Address - Phone:804-966-2242
Mailing Address - Fax:804-966-1643
Practice Address - Street 1:3627 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-2910
Practice Address - Country:US
Practice Address - Phone:804-228-3501
Practice Address - Fax:804-228-3504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUMBERLAND HOSPITAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA549-14-005320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities