Provider Demographics
NPI:1508024738
Name:CUMBERLAND OUTPATIENT REHAB
Entity Type:Organization
Organization Name:CUMBERLAND OUTPATIENT REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-862-0605
Mailing Address - Street 1:1380 HIGHWAY 192 E
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-3123
Mailing Address - Country:US
Mailing Address - Phone:606-862-0605
Mailing Address - Fax:606-862-0949
Practice Address - Street 1:1380 HIGHWAY 192 E
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3123
Practice Address - Country:US
Practice Address - Phone:606-862-0605
Practice Address - Fax:606-862-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty