Provider Demographics
NPI:1699967430
Name:UPPER CUMBERLAND COMMUNITY SERVICES AGENCY
Entity type:Organization
Organization Name:UPPER CUMBERLAND COMMUNITY SERVICES AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-520-0200
Mailing Address - Street 1:1000 ENGLAND DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0940
Mailing Address - Country:US
Mailing Address - Phone:931-520-0200
Mailing Address - Fax:931-520-0080
Practice Address - Street 1:1000 ENGLAND DR
Practice Address - Street 2:SUITE F
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0940
Practice Address - Country:US
Practice Address - Phone:931-520-0200
Practice Address - Fax:931-520-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT000196OtherTENNCARE/MEDICAID