Healthcare Provider Details

I. General information

NPI: 1891471256
Provider Name (Legal Business Name): CUMBERLAND CREEK ASSISTED LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 CEDAR CREEK RD
FAYETTEVILLE NC
28312-6544
US

IV. Provider business mailing address

4749 US HIGHWAY 701 BUS S
CLARKTON NC
28433-9758
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-8212
  • Fax: 910-485-0890
Mailing address:
  • Phone: 910-862-3693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MARY-MARGARET LENNON CLIFTON
Title or Position: PRESIDENT
Credential:
Phone: 910-874-4226