Provider Demographics
NPI:1255681805
Name:THE CORNERSTONE OF RECOVERY, INC.
Entity Type:Organization
Organization Name:THE CORNERSTONE OF RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OHIO OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONTA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICDC, LSW
Authorized Official - Phone:614-889-0000
Mailing Address - Street 1:5003 HORIZONS DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220
Mailing Address - Country:US
Mailing Address - Phone:614-889-0000
Mailing Address - Fax:614-846-1916
Practice Address - Street 1:5003 HORIZONS DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220
Practice Address - Country:US
Practice Address - Phone:614-889-0000
Practice Address - Fax:614-846-1916
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CORNERSTONE OF RECOVERY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-11
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12833251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12833OtherOHIO DEPARTMENT OF ALCOHOL AND DRUG ADDICTION SERVICES
OH0075958Medicaid