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General NPI Number Information
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NPI Number | 1235276213
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Entity Type | Organization
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Legal Business Name | CUMBERLAND MOUNTAIN INDUSTRIES, INC.
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 1214 CEDAR FORK RD
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City | TAZEWELL
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State | TN
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Zip | 37879-5000
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Country | US
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Telephone | 423-626-6757
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Fax | 423-626-2358
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Provider Business Mailing Address
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Address Line | 1214 CEDAR FORK RD
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City | TAZEWELL
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State | TN
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Zip | 37879-5000
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Country | US
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Telephone | 423-626-6757
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Fax | 423-626-2358
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. STEVE MINTON
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Credential |
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Telephone | 423-626-6757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | L000000008714
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | L000000008714
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License Number State | TN
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