Healthcare Provider Details

I. General information

NPI: 1326931031
Provider Name (Legal Business Name): CRADLE OF HUMANITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MAIN ST
BECKLEY WV
25801-4611
US

IV. Provider business mailing address

110 MAIN ST
BECKLEY WV
25801-4611
US

V. Phone/Fax

Practice location:
  • Phone: 732-917-5723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY NTUMSI
Title or Position: CEO
Credential:
Phone: 732-917-5723