Provider Demographics
NPI:1336307099
Name:CORNERSTONE TREATMENT FACILITY INC
Entity Type:Organization
Organization Name:CORNERSTONE TREATMENT FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:SURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-733-0617
Mailing Address - Street 1:1892 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8520
Mailing Address - Country:US
Mailing Address - Phone:910-266-8891
Mailing Address - Fax:352-293-3128
Practice Address - Street 1:129 WALLACE ROAD
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2434
Practice Address - Country:US
Practice Address - Phone:910-266-8891
Practice Address - Fax:352-293-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children