Provider Demographics
NPI:1760525596
Name:CUMBERLAND VALLEY CHILDRENS ADVOCACY CTR
Entity Type:Organization
Organization Name:CUMBERLAND VALLEY CHILDRENS ADVOCACY CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL UNIT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:606-878-9116
Mailing Address - Street 1:1130 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2529
Mailing Address - Country:US
Mailing Address - Phone:606-878-9116
Mailing Address - Fax:
Practice Address - Street 1:1130 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2529
Practice Address - Country:US
Practice Address - Phone:606-878-9116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY13000047Medicaid