Healthcare Provider Details

I. General information

NPI: 1447570221
Provider Name (Legal Business Name): CUMBERLAND TARGETED CASE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6204 RUSTIC RDG
HOPE MILLS NC
28348-2711
US

IV. Provider business mailing address

6204 RUSTIC RDG
HOPE MILLS NC
28348-2711
US

V. Phone/Fax

Practice location:
  • Phone: 910-574-0966
  • Fax:
Mailing address:
  • Phone: 910-574-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LOUISE N JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 910-574-0966