1649646787 NPI number — CORNERSTONE BEHAVIORAL HEALTH TUCSON

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649646787 NPI number — CORNERSTONE BEHAVIORAL HEALTH TUCSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE BEHAVIORAL HEALTH TUCSON
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:
6
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:
1649646787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 ROSS AVE STE 5400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75201-7918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-621-6700
Provider Business Mailing Address Fax Number:
469-621-6678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 N WILMOT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712-4498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-222-8268
Provider Business Practice Location Address Fax Number:
520-282-4247
Provider Enumeration Date:
08/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LAWRENCE
Authorized Official First Name:
CHARLOTTE
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
615-920-7688

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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