1649646787 NPI number — CORNERSTONE BEHAVIORAL HEALTH TUCSON

Table of content: (NPI 1649646787)

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:
CORNERSTONE BEHAVIORAL HEALTH EL DORADO
Provider Other Organization Name Type Code:
3
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)





Copyright © 2007-2024 www.npivalidator.com