1336307099 NPI number — CORNERSTONE TREATMENT FACILITY INC

Table of content: (NPI 1336307099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336307099 NPI number — CORNERSTONE TREATMENT FACILITY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE TREATMENT FACILITY INC
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:
1336307099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1892 TURNPIKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAEFORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28376-8520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-266-8891
Provider Business Mailing Address Fax Number:
352-293-3128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 WALLACE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WADESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28170-2434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-266-8891
Provider Business Practice Location Address Fax Number:
352-293-3128
Provider Enumeration Date:
05/29/2008

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:
910-733-0617

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)





Copyright © 2007-2024 www.npivalidator.com