MEDICARE: CORNERSTONE MONTGOMERY, INC.

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	320800000X	Mental Illness Community Based Residential Treatment Facility	MH-1045	MD

General Provider Information

NPI Number	:	1891167706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE MONTGOMERY, INC.

Provider Business Mailing Address
First Line	:	6040 SOUTHPORT DR
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-1848
Country	:	US
Telephone Number	:	301-493-4200
Fax Number	:	301-493-6209

Provider Business Practice Location Address
First Line	:	8915 COLESVILLE RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4339
Country	:	US
Telephone Number	:	301-493-4200
Fax Number	:	301-493-6209

Authorized Official
Title or Position	:	CFO
Name	:	GWENDOLYN ZECHA
Credential	:
Telephone Number	:	301-896-4262

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	10/30/2015

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