Healthcare Provider Details

I. General information

NPI: 1700337656
Provider Name (Legal Business Name): CORNERSTONE DELIVERANCE & DEVELOPMENT MINISTRIES FOR CHRIST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2016
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 NW 35TH AVENUE
FORT LAUDERDALE FL
33311
US

IV. Provider business mailing address

3090 NW 7TH STREET
FORT LAUDERDALE FL
33311-7612
US

V. Phone/Fax

Practice location:
  • Phone: 954-526-4117
  • Fax: 954-827-0285
Mailing address:
  • Phone: 954-526-4117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW J. JONES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 954-642-1583