Provider Demographics
NPI:1356010243
Name:FIVE CORNERS BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:FIVE CORNERS BEHAVIORAL HEALTH, LLC
Other - Org Name:FIVE CORNERS BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTIOIONTER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-205-7416
Mailing Address - Street 1:115 BIRDSEYE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2481
Mailing Address - Country:US
Mailing Address - Phone:860-205-7416
Mailing Address - Fax:860-678-9308
Practice Address - Street 1:115 BIRDSEYE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2481
Practice Address - Country:US
Practice Address - Phone:860-205-7416
Practice Address - Fax:860-678-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty