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CUMBERLAND MOUNTAIN COMMUNITY

Intermediate Care Mentally Retarded

Keen Mountain, Virginia

Provider NPI: 1609916386

Organization Information:
Organization Name:  CUMBERLAND MOUNTAIN COMMUNITY
Organization is Subpart
Authorized Official:  MARY F COLE  MENTAL RETARDATION DIRECTOR  276-9646702

Practice Location:
ROUTE 696  KEEN MOUNTAIN, VA 24624 US
Tel: 276-498-4549  Fax: 276-498-4194

Business Mailing Address:
PO BOX 810  CEDAR BLUFF, VA 24609 US
Tel: 276-964-6702  Fax: 276-964-5669

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
VA09301001

Other Provider Identifiers:

IssuerNumberStateType
004967810VA05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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