Healthcare Provider Details

I. General information

NPI: 1730876350
Provider Name (Legal Business Name): CORNERSTONE TREATMENT CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 07/16/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 PENNSYLVANIA AVENUE
BALTIMORE MD
21217
US

IV. Provider business mailing address

1806 PENNSYLVANIA AVENUE
BALTIMORE MD
21217
US

V. Phone/Fax

Practice location:
  • Phone: 240-882-0536
  • Fax:
Mailing address:
  • Phone: 240-882-0536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: FOLAKE ALOBA
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 240-713-4921