Healthcare Provider Details

I. General information

NPI: 1407798051
Provider Name (Legal Business Name): AVIE CORNERSTONE COMMUNITY LIVING & SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CARRIE PL
SICKLERVILLE NJ
08081-9609
US

IV. Provider business mailing address

1 CARRIE PL
SICKLERVILLE NJ
08081-9609
US

V. Phone/Fax

Practice location:
  • Phone: 856-215-4100
  • Fax:
Mailing address:
  • Phone: 856-215-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COBIE COURSEY BEATTY
Title or Position: OWNER
Credential:
Phone: 856-215-4100