Provider Demographics
NPI:1821537739
Name:THE CORNERSTONE RECOVERING COMMUNITY
Entity Type:Organization
Organization Name:THE CORNERSTONE RECOVERING COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:MILES
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-909-2424
Mailing Address - Street 1:9910 S KING DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1524
Mailing Address - Country:US
Mailing Address - Phone:773-909-2424
Mailing Address - Fax:
Practice Address - Street 1:28 W 113TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4811
Practice Address - Country:US
Practice Address - Phone:773-909-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILC/A-8672-0003-A324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility