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General NPI Number Information
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NPI Number | 1558479758
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Entity Type | Organization
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Legal Business Name | CORNERSTONE OF RECOVERY
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 4718 ALCOA HWY
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City | LOUISVILLE
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State | TN
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Zip | 37777-5402
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Country | US
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Telephone | 865-970-7747
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Fax |
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Provider Business Mailing Address
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Address Line | 4726 AIRPORT HWY
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City | LOUISVILLE
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State | TN
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Zip | 37777-5402
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Country | US
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Telephone | 865-970-7747
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Fax | 865-681-2266
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Authorized Official
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Title or Position | CFO
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Name | MARK EDWARDS
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Credential |
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Telephone | 205-244-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 100000002973
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License Number State | TN
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