Healthcare Provider Details

I. General information

NPI: 1205900743
Provider Name (Legal Business Name): CUMBERLAND RIVER HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OLD JEFFERSON STREET
CELINA TN
38551-4040
US

IV. Provider business mailing address

100 OLD JEFFERSON STREET PO BOX 427
CELINA TN
38551-4040
US

V. Phone/Fax

Practice location:
  • Phone: 931-243-3680
  • Fax: 931-243-5219
Mailing address:
  • Phone: 931-243-3680
  • Fax: 931-243-5219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number135
License Number StateTN

VIII. Authorized Official

Name: PATRICIA LYNNE STRONG
Title or Position: CFO
Credential:
Phone: 931-243-3581