Healthcare Provider Details

I. General information

NPI: 1598807497
Provider Name (Legal Business Name): CUMBERLAND HCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N MARIETTA ST
GREENUP IL
62428-1103
US

IV. Provider business mailing address

300 N MARIETTA ST
GREENUP IL
62428-1103
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-8113
  • Fax: 309-691-8622
Mailing address:
  • Phone: 217-923-3186
  • Fax: 816-276-0150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE REDBURN
Title or Position: REVENUE CYCLE COMPLIANCE AUDITOR
Credential:
Phone: 816-444-0900