Provider Demographics
NPI:1689817793
Name:MID-ATLANTIC OF CUMBERLAND LLC
Entity Type:Organization
Organization Name:MID-ATLANTIC OF CUMBERLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTS RECEIVABLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-923-2415
Mailing Address - Street 1:730 FURNACE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1564
Mailing Address - Country:US
Mailing Address - Phone:301-777-5941
Mailing Address - Fax:
Practice Address - Street 1:730 FURNACE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1564
Practice Address - Country:US
Practice Address - Phone:301-777-5941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417433000OtherMEDICAID B CO-INSURANCE
MD416653100Medicaid
MD416653100Medicaid