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General NPI Number Information
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NPI Number | 1720376031
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Entity Type | Organization
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Legal Business Name | CORNERSTONE AFC LLC
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 633 N FALL RIVER DR
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City | COLDWATER
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State | MI
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Zip | 49036-9170
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Country | US
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Telephone | 269-317-4433
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 277
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City | BLOOMINGDALE
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State | MI
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Zip | 49026-0277
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TRACIE HERNANDEZ
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Credential |
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Telephone | 269-317-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | AS120281503
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License Number State | MI
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