MEDICARE: CORNERSTONE RECOVERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1548912892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE RECOVERY CENTER LLC

Provider Business Mailing Address
First Line	:	114 S MAIN ST
Second Line	:
City	:	MEDFORD
State	:	NJ
Zip	:	08055-2423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8911 LINDLEY AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-2725
Country	:	US
Telephone Number	:	856-994-3220
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC BELL
Credential	:
Telephone Number	:	856-994-3220

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	05/28/2026

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