MEDICARE: CORNERSTONE RECOVERY CENTER, INC.

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	324500000X	Substance Abuse Rehabilitation Facility	1706AD975201	FL

General Provider Information

NPI Number	:	1477801090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE RECOVERY CENTER, INC.

Provider Business Mailing Address
First Line	:	3223 NW 10TH TER
Second Line	:	SUITE 610
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-5940
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3223 NW 10TH TER
Second Line	:	SUITE 610
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-5940
Country	:	US
Telephone Number	:	754-201-2265
Fax Number	:

Authorized Official
Title or Position	:	ACCOUNT SPECIALIST
Name	:	JOSE FLORES
Credential	:
Telephone Number	:	754-201-2265

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	08/29/2012

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