MEDICARE: CUMBERLAND ASSOCIATES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750658001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUMBERLAND ASSOCIATES INC.

Provider Business Mailing Address
First Line	:	120 COURTHOUSE SQUARE
Second Line	:	PO BOX 385
City	:	TOLEDO
State	:	IL
Zip	:	62468-9998
Country	:	US
Telephone Number	:	217-849-3803
Fax Number	:	217-849-3804

Provider Business Practice Location Address
First Line	:	120 COURTHOUSE SQUARE
Second Line	:
City	:	TOLEDO
State	:	IL
Zip	:	62468-9998
Country	:	US
Telephone Number	:	217-849-3803
Fax Number	:	217-849-3804

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. DEBORAH A MATTHEW
Credential	:
Telephone Number	:	217-849-3803

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	11/30/2011

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