Provider Demographics
NPI:1790043099
Name:CUMBERLAND MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:CUMBERLAND MEMORIAL HOSPITAL INC
Other - Org Name:TURTLE LAKE REHAB CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-822-7252
Mailing Address - Street 1:1705 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54829-8601
Mailing Address - Country:US
Mailing Address - Phone:715-822-7222
Mailing Address - Fax:715-822-2740
Practice Address - Street 1:632 US HIGHWAY 8 W
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54889-4411
Practice Address - Country:US
Practice Address - Phone:715-822-4301
Practice Address - Fax:715-986-2236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUMBERLAND MEMORIAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-25
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1058225100000X, 2255A2300X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty