Healthcare Provider Details

I. General information

NPI: 1043146822
Provider Name (Legal Business Name): CORNERSTONE ADVENTUROUS BLESSINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S LINDEN ST
PINE BLUFF AR
71601-3948
US

IV. Provider business mailing address

1120 W 5TH AVE
PINE BLUFF AR
71601-3916
US

V. Phone/Fax

Practice location:
  • Phone: 870-281-8962
  • Fax:
Mailing address:
  • Phone: 870-281-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: WILLIE D TARRESSA JACKSON
Title or Position: OWNER
Credential:
Phone: 870-281-8962