Healthcare Provider Details

I. General information

NPI: 1437483872
Provider Name (Legal Business Name): CORNERSTONE TREATMENT FACILITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 WALLACE ROAD
WADESBORO NC
28170-2434
US

IV. Provider business mailing address

3195 SELHURST CT
FAYETTEVILLE NC
28306-7542
US

V. Phone/Fax

Practice location:
  • Phone: 910-322-9817
  • Fax: 850-515-0260
Mailing address:
  • Phone: 850-515-0220
  • Fax: 850-515-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK SURGEON
Title or Position: CEO
Credential:
Phone: 910-733-0617