Provider Demographics
NPI:1134140007
Name:CORNERSTONE BEHAVIORAL HEALTH GROUP
Entity Type:Organization
Organization Name:CORNERSTONE BEHAVIORAL HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-825-5128
Mailing Address - Street 1:1430 E COOLEY DR
Mailing Address - Street 2:STE. 111
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3934
Mailing Address - Country:US
Mailing Address - Phone:909-825-5128
Mailing Address - Fax:909-825-8568
Practice Address - Street 1:1430 E COOLEY DR
Practice Address - Street 2:STE. 111
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3934
Practice Address - Country:US
Practice Address - Phone:909-825-5128
Practice Address - Fax:909-825-8568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 130701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty