Provider Demographics
NPI:1225391402
Name:CORNERSTONE RECOVERY CENTER
Entity Type:Organization
Organization Name:CORNERSTONE RECOVERY CENTER
Other - Org Name:ROYAL LIFE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:X
Authorized Official - Last Name:CID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-866-0012
Mailing Address - Street 1:701 S SWINTON AVE
Mailing Address - Street 2:APT G
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-2377
Mailing Address - Country:US
Mailing Address - Phone:928-515-2441
Mailing Address - Fax:928-771-3705
Practice Address - Street 1:655 W GURLEY ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3619
Practice Address - Country:US
Practice Address - Phone:928-515-2441
Practice Address - Fax:928-771-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC7457251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health