Healthcare Provider Details

I. General information

NPI: 1740104116
Provider Name (Legal Business Name): CORNERSTONE RECOVERY RESIDENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 VERNON ST
WORCESTER MA
01610
US

IV. Provider business mailing address

12 GAMBIA ST
HUDSON NH
03051-3624
US

V. Phone/Fax

Practice location:
  • Phone: 978-866-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DAN MURPHY
Title or Position: OWNER
Credential:
Phone: 978-221-5967