MEDICARE: CORNERSTONE PROJECT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1275068819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE PROJECT LLC

Provider Business Mailing Address
First Line	:	4124 LINDEN AVE
Second Line	:	SUITE 100
City	:	DAYTON
State	:	OH
Zip	:	45432-3018
Country	:	US
Telephone Number	:	937-727-4907
Fax Number	:

Provider Business Practice Location Address
First Line	:	4124 LINDEN AVE
Second Line	:	SUITE 100
City	:	DAYTON
State	:	OH
Zip	:	45432-3018
Country	:	US
Telephone Number	:	937-727-4907
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MICHAEL WARD
Credential	:
Telephone Number	:	937-522-0961

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	05/28/2019

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