Cubbull, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

200900009S Issued in IL

Legal business name

CUBBULL, INC.

Practice address

121 W Elm St
Box 478
Canton, IL 61520-2513

Phone

(309) 224-4093

NPI assigned

May 2, 2016

Last updated

May 2, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Susan L Barnhart, RN, MS, MAED, QIDP

Title

President

Phone

(309) 224-4093

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1462147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462147200000",
    "number": "1649625377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 W ELM ST",
            "address_2": "BOX 478",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202513",
            "telephone_number": "309-224-4093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 W ELM ST",
            "address_2": "BOX 478",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202513",
            "telephone_number": "309-224-4093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUBBULL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-02",
        "last_updated": "2016-05-02",
        "status": "A",
        "authorized_official_last_name": "BARNHART",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-224-4093",
        "authorized_official_credential": "RN, MS, MAED, QIDP"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": "200900009S",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassidy Dianne Collier, M.S., CF-SLP
• Dawn Marie Cousins, APN
• Helen Dianne Cox, DEVELOPMENTAL THERAP
• Kelsey Rae Cox
• Alyssa Crawford
• John Howard Day, MD
• Brianna Dean
• David W Dean, M.D.
• Sandi Greene Deford, M.S.
• Gerri Delost, CRNA

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Canton, IL
• Providers in Canton, IL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2016; 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.