Provider Demographics
NPI:1295495497
Name:CORNERSTONE DELIVERANCE & DEVELOPMENT MINISTRIES FOR CHRIST, INC
Entity type:Organization
Organization Name:CORNERSTONE DELIVERANCE & DEVELOPMENT MINISTRIES FOR CHRIST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:COURTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-642-1583
Mailing Address - Street 1:3090 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-7612
Mailing Address - Country:US
Mailing Address - Phone:954-642-1583
Mailing Address - Fax:954-827-0285
Practice Address - Street 1:101 W STUART AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:GA
Practice Address - Zip Code:30436-1437
Practice Address - Country:US
Practice Address - Phone:954-951-2705
Practice Address - Fax:954-827-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No177F00000XOther Service ProvidersLodging
No253J00000XAgenciesFoster Care Agency
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty