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General NPI Number Information
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NPI Number | 1962112854
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Entity Type | Organization
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Legal Business Name | CUMBERLAND KY OPCO LLC
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 301 S MAIN ST
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City | BURKESVILLE
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State | KY
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Zip | 42717-9625
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Country | US
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Telephone | 917-418-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 150 OBERLIN AVE N STE 6
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | ELI GRINSPAN
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Credential |
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Telephone | 917-418-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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