Healthcare Provider Details

I. General information

NPI: 1720384423
Provider Name (Legal Business Name): CUMBERLAND CO. HOSPITAL SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 ROXIE AVE
FAYETTEVILLE NC
28304-1623
US

IV. Provider business mailing address

1724 ROXIE AVE
FAYETTEVILLE NC
28304-1623
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-3370
  • Fax: 910-615-7967
Mailing address:
  • Phone: 910-615-3370
  • Fax: 910-615-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberMHL026914
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License NumberMHL026914
License Number StateNC

VIII. Authorized Official

Name: MR. MICHAEL NAGOWSKI
Title or Position: CEO
Credential:
Phone: 910-615-6700