Provider Demographics
NPI:1720384423
Name:CUMBERLAND CO. HOSPITAL SYSTEM INC
Entity Type:Organization
Organization Name:CUMBERLAND CO. HOSPITAL SYSTEM INC
Other - Org Name:ROXIE AVENUE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-615-6700
Mailing Address - Street 1:1724 ROXIE AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-1623
Mailing Address - Country:US
Mailing Address - Phone:910-615-3370
Mailing Address - Fax:910-615-7967
Practice Address - Street 1:1724 ROXIE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1623
Practice Address - Country:US
Practice Address - Phone:910-615-3370
Practice Address - Fax:910-615-7967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL026914273R00000X, 276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No273R00000XHospital UnitsPsychiatric Unit