Provider Demographics
NPI:1538287610
Name:CUMBERLAND COUNTY COORDINATING COUNCIL ON OLDER ADULTS, INC.
Entity Type:Organization
Organization Name:CUMBERLAND COUNTY COORDINATING COUNCIL ON OLDER ADULTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:VAN SICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-484-0111
Mailing Address - Street 1:339 DEVERS ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4750
Mailing Address - Country:US
Mailing Address - Phone:910-484-0111
Mailing Address - Fax:910-484-0627
Practice Address - Street 1:339 DEVERS ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4750
Practice Address - Country:US
Practice Address - Phone:910-484-0111
Practice Address - Fax:910-484-0627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0752251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408127Medicaid
NC6600025Medicaid