1922445790 NPI number — CORNERSTONE TREATMENT FACILTIY

Table of content: (NPI 1922445790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922445790 NPI number — CORNERSTONE TREATMENT FACILTIY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE TREATMENT FACILTIY
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:
1922445790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3620 LEGION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPE MILLS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28348-8412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-389-0539
Provider Business Mailing Address Fax Number:
877-472-2302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13178 NC HIGHWAY 130 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRMONT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28340-9597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-472-2302
Provider Business Practice Location Address Fax Number:
877-472-2302
Provider Enumeration Date:
06/03/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SURGEON
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
850-515-0220

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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