1558479758 NPI number — CORNERSTONE OF RECOVERY

Table of content: (NPI 1558479758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558479758 NPI number — CORNERSTONE OF RECOVERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE OF RECOVERY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558479758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1214 TOPSIDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37777-5505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-970-7747
Provider Business Mailing Address Fax Number:
865-681-2266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1214 TOPSIDE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37777-5505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-970-7747
Provider Business Practice Location Address Fax Number:
865-681-2266
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CALDWELL
Authorized Official First Name:
DAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
865-970-7747

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  100000002973 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000000010584 . This is a "DEPARTMENT OF MENTAL HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: L000000008360 . This is a "DEPARTMENT OF MENTAL HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 12833 . This is a "OHIO DEPARTMENT OF ALCOHOL AND DRUG ADDICTION SERVICES" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: L000000008359 . This is a "DEPARTMENT OF MENTAL HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: L000000008361 . This is a "DEPARTMENT OF MENTAL HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: L000000008362 . This is a "DEPARTMENT OF MENTAL HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1000000010585 . This is a "DEPARTMENT OF HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1000000010583 . This is a "DEPARTMENT OF MENTAL HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com