Healthcare Provider Details

I. General information

NPI: 1760525596
Provider Name (Legal Business Name): CUMBERLAND VALLEY CHILDRENS ADVOCACY CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 E 4TH ST
LONDON KY
40741-2529
US

IV. Provider business mailing address

1130 E 4TH ST
LONDON KY
40741-2529
US

V. Phone/Fax

Practice location:
  • Phone: 606-878-9116
  • Fax:
Mailing address:
  • Phone: 606-878-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY L GEORGE
Title or Position: MEDICAL UNIT COORDINATOR
Credential: RN
Phone: 606-878-9116