Provider Demographics
NPI:1790096030
Name:CORNERSTONE COMMUNITY SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:CORNERSTONE COMMUNITY SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-478-3605
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SPRING HOPE
Mailing Address - State:NC
Mailing Address - Zip Code:27882-0160
Mailing Address - Country:US
Mailing Address - Phone:252-478-3605
Mailing Address - Fax:252-478-3618
Practice Address - Street 1:831 S BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4385
Practice Address - Country:US
Practice Address - Phone:252-478-3605
Practice Address - Fax:252-478-2516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-064-105251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL-064-105OtherSTATE LICENSE
NC8302264Medicaid