1285969279 NPI number — CORNERSTONE TREATMENT FACILITY, INC.

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 1285969279 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:
1285969279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
733 BARGAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28303-3494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-472-2302
Provider Business Mailing Address Fax Number:
877-472-2302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 WALLACE RD
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:
704-695-0601
Provider Business Practice Location Address Fax Number:
704-695-0607
Provider Enumeration Date:
10/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SURGEON
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
910-733-0617

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3404556 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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