MEDICARE: CORNERSTONE URBAN ALLIANCE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2083P0901X	Public Health & General Preventive Medicine Physician
2	172V00000X	Community Health Worker
3	251B00000X	Case Management Agency
4	101YA0400X	Addiction (Substance Use Disorder) Counselor
5	225C00000X	Rehabilitation Counselor
6	104100000X	Social Worker
7	101YM0800X	Mental Health Counselor
8	106S00000X	Behavior Technician
9	2083T0002X	Medical Toxicology (Preventive Medicine) Physician
10	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1730026097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE URBAN ALLIANCE

Provider Business Mailing Address
First Line	:	11000 W MCNICHOLS RD STE 323
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-2393
Country	:	US
Telephone Number	:	800-313-6403
Fax Number	:

Provider Business Practice Location Address
First Line	:	3761 HARDING ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-1534
Country	:	US
Telephone Number	:	800-313-6403
Fax Number	:

Authorized Official
Title or Position	:	PROJECT DIRECTOR
Name	:	ASHTYN GIBSON
Credential	:
Telephone Number	:	510-610-9096

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/09/2026

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Directions to “CORNERSTONE URBAN ALLIANCE ” Practice Location

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