Healthcare Provider Details

I. General information

NPI: 1700128360
Provider Name (Legal Business Name): CORNERSTONE HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 EASTCHESTER DR SUITE 107A
HIGH POINT NC
27265-3170
US

IV. Provider business mailing address

1701 WESTCHESTER DR SUITE 850
HIGH POINT NC
27262-7008
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2291
  • Fax: 336-802-2292
Mailing address:
  • Phone: 336-802-2400
  • Fax: 336-802-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHARLES DOUGLAS MATHIS
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 336-802-2536