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General NPI Number Information
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NPI Number | 1205050580
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Entity Type | Organization
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Legal Business Name | CUMBERLAND COVENANT HOUSE LLC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | 11810 BEDFORD RD NE
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City | CUMBERLAND
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State | MD
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Zip | 21502-6990
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Country | US
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Telephone | 301-722-6881
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Fax | 301-722-6690
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Provider Business Mailing Address
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Address Line | 11810 BEDFORD RD NE
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City | CUMBERLAND
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State | MD
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Zip | 21502-6990
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Country | US
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Telephone | 301-722-6681
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Fax | 301-722-6690
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Authorized Official
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Title or Position | CEO
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Name | SUE L ROOT
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Credential |
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Telephone | 301-722-6681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 10570
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License Number State | MD
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