Healthcare Provider Details

I. General information

NPI: 1427247287
Provider Name (Legal Business Name): CORNERSTONE COMMUNITY SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6291 E. MAIN STREET
BAILEY NC
27807-8990
US

IV. Provider business mailing address

6291 E. MAIN STREET
BAILEY NC
27807-8990
US

V. Phone/Fax

Practice location:
  • Phone: 252-235-2536
  • Fax: 252-235-2816
Mailing address:
  • Phone: 252-235-2536
  • Fax: 252-235-2816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL MERCER
Title or Position: DIRECTOR
Credential:
Phone: 252-235-2536