Provider Demographics
NPI:1710556808
Name:CORNERSTONE HEALING CENTER, LLC
Entity Type:Organization
Organization Name:CORNERSTONE HEALING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ESTIL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-544-6832
Mailing Address - Street 1:22200 N 97TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4414
Mailing Address - Country:US
Mailing Address - Phone:800-480-1781
Mailing Address - Fax:480-590-7303
Practice Address - Street 1:22200 N 97TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4414
Practice Address - Country:US
Practice Address - Phone:800-480-1781
Practice Address - Fax:480-590-7303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE HEALING CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-22
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility