Provider Demographics
NPI:1790454486
Name:CUMBERLAND RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:CUMBERLAND RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YANNICK
Authorized Official - Middle Name:
Authorized Official - Last Name:NDAYISENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-232-0419
Mailing Address - Street 1:2566 E CALLE TOBO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-0048
Mailing Address - Country:US
Mailing Address - Phone:607-232-0419
Mailing Address - Fax:
Practice Address - Street 1:2566 E CALLE TOBO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-0048
Practice Address - Country:US
Practice Address - Phone:607-232-0419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251E00000XAgenciesHome Health