NPIMap

Organization Active NPI

Cumberland Residential & Employment Services& Training

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Fayetteville, NC
National Provider Identifier
1508909144
Registry record updated Jul 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL-026-639 Issued in NC
Legal business name
CUMBERLAND RESIDENTIAL & EMPLOYMENT SERVICES& TRAINING
Practice address
245 Tillinghast St
Fayetteville, NC 28301-4747
Phone
(910) 487-3131
Fax
(910) 487-0637
NPI assigned
Feb 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Dwayne K. Patterson
Title
Executive Director
Phone
(910) 487-3131

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-026-639 NC Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-026-640 NC
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-026-641 NC
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-026-642 NC
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL-026-643 NC

Addresses

Primary practice location

245 Tillinghast St
Fayetteville, NC 28301-4747

Mailing address

PO Box 877
Fayetteville, NC 28302-0877
Phone (910) 487-3131

Other identifiers 5

IdentifierTypeStateIssuer
7804522MedicaidNC
7804521MedicaidNC
7804519MedicaidNC
7804520MedicaidNC
7804523MedicaidNC

Other names 1

  • CREST Other name

National Provider Directory

National Provider Directory
Tax ID family
Crest6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

245 Tillinghast St
Fayetteville, NC 28301
Phone (910) 487-3131

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406592000000",
    "number": "1508909144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 877",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283020877",
            "telephone_number": "910-487-3131",
            "fax_number": "910-487-0637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 TILLINGHAST ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283014747",
            "telephone_number": "910-487-3131",
            "fax_number": "910-487-0637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND RESIDENTIAL & EMPLOYMENT SERVICES& TRAINING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2014-07-29",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "910-487-3131",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-026-639",
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-026-640",
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-026-641",
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-026-642",
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-026-643",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804522",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804521",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804519",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804520",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804523",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CREST",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.