NPIMap

Organization Active NPI

Cumberland Residential & Employment Services & Training

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Fayetteville, NC
National Provider Identifier
1659415677
Registry record updated Jul 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL-026-643 Issued in NC
Legal business name
CUMBERLAND RESIDENTIAL & EMPLOYMENT SERVICES & TRAINING
Practice address
250 Prince Charles Dr
Fayetteville, NC 28311-0834
Phone
(910) 487-3131
Fax
(910) 487-0637
NPI assigned
Feb 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2012

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 1

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

Addresses

Primary practice location

250 Prince Charles Dr
Fayetteville, NC 28311-0834

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
7804519MedicaidNC

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.

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341964800000",
    "number": "1659415677",
    "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": "250 PRINCE CHARLES DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283110834",
            "telephone_number": "910-487-3131",
            "fax_number": "910-487-0637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND RESIDENTIAL & EMPLOYMENT SERVICES & TRAINING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2012-07-11",
        "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-026-643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804519",
            "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 11, 2012; 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.