Provider Demographics
NPI:1942334263
Name:CUMBERLAND RIVER HOMES, INC.
Entity Type:Organization
Organization Name:CUMBERLAND RIVER HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-988-4913
Mailing Address - Street 1:111 N HAYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:KY
Mailing Address - Zip Code:42078-8073
Mailing Address - Country:US
Mailing Address - Phone:270-988-4913
Mailing Address - Fax:270-988-3128
Practice Address - Street 1:111 N HAYDEN AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078-8073
Practice Address - Country:US
Practice Address - Phone:270-988-4913
Practice Address - Fax:270-988-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1942334263Medicaid