Provider Demographics
NPI:1801287842
Name:CORNERSTONE OF THE PALM BEACHES,INC.
Entity type:Organization
Organization Name:CORNERSTONE OF THE PALM BEACHES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:RODRIGUEZ-DIAZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:317-671-4540
Mailing Address - Street 1:1551 FORUM PL
Mailing Address - Street 2:BLDG #400 SUITE-D
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2319
Mailing Address - Country:US
Mailing Address - Phone:561-623-7106
Mailing Address - Fax:561-623-7976
Practice Address - Street 1:1551 FORUM PL
Practice Address - Street 2:BLDG #400 SUITE-D
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2319
Practice Address - Country:US
Practice Address - Phone:561-623-7106
Practice Address - Fax:561-623-7976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0156122-00Medicaid
FL0156122-00Medicaid