Healthcare Provider Details

I. General information

NPI: 1497125223
Provider Name (Legal Business Name): CUMBERLAND HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 CAROLINA AVE
RICHMOND VA
23222-2910
US

IV. Provider business mailing address

9407 CUMBERLAND RD
NEW KENT VA
23124-2029
US

V. Phone/Fax

Practice location:
  • Phone: 804-228-3501
  • Fax: 804-228-3504
Mailing address:
  • Phone: 804-966-2242
  • Fax: 804-966-1643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number549-14-005
License Number StateVA

VIII. Authorized Official

Name: MRS. PATRICE GAY BROOKS
Title or Position: CEO
Credential:
Phone: 804-966-2242