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General NPI Number Information
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NPI Number | 1740324763
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Entity Type | Organization
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Legal Business Name | CUMBERLAND RESIDENTIAL & EMPLOYMENT SERVICES & TRAINING
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 224 RANDOLPH AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-2743
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Country | US
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Telephone | 910-487-3131
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Fax | 910-487-0637
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Provider Business Mailing Address
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Address Line | PO BOX 877
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City | FAYETTEVILLE
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State | NC
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Zip | 28302-0877
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Country | US
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Telephone | 910-487-3131
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Fax | 910-487-0637
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DWAYNE K. PATTERSON
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Credential |
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Telephone | 910-487-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL-026-642
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License Number State | NC
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