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General NPI Number Information
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NPI Number | 1063954469
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Entity Type | Organization
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Legal Business Name | CORNERSTONE BEHAVIORAL HEALTH SERVICES INC
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 125 N MECKLENBURG AVE
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City | SOUTH HILL
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State | VA
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Zip | 23970-2045
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Country | US
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Telephone | 434-584-9845
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Fax | 434-584-9810
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Provider Business Mailing Address
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Address Line | 125 N MECKLENBURG AVE
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City | SOUTH HILL
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State | VA
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Zip | 23970-2045
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Country | US
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Telephone | 434-584-9845
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Fax | 434-584-9810
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Authorized Official
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Title or Position | CEO, OWNER
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Name | GEORGE BREEDLOVE
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Credential |
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Telephone | 804-248-7367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1843-03-002
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License Number State | VA
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