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General NPI Number Information
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NPI Number | 1801271366
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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 | 07/27/2015
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 109 DRUID LN
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City | DANVILLE
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State | VA
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Zip | 24541-4923
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Country | US
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Telephone | 434-857-5612
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Fax | 434-857-5618
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Provider Business Mailing Address
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Address Line | 212 NORTH UNION STREET
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City | DANVILLE
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State | VA
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Zip | 24541-0000
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Country | US
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Telephone | 434-334-7065
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Fax |
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Authorized Official
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Title or Position | CEO, OWNER
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Name | MR. 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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 1843
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 1843
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License Number State | VA
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