MEDICARE: CORNERSTONE TREATMENT FACILITY PROGRAM INC,

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor
4	1041C0700X	Clinical Social Worker
5	2084P0804X	Child & Adolescent Psychiatry Physician
6	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1669765921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE TREATMENT FACILITY PROGRAM INC,

Provider Business Mailing Address
First Line	:	2990 SUNNYSIDE SCHOOL RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28312-6914
Country	:	US
Telephone Number	:	850-512-9166
Fax Number	:	877-472-2302

Provider Business Practice Location Address
First Line	:	778 HOFFMAN ROAD
Second Line	:
City	:	JACKSON SPRINGS
State	:	NC
Zip	:	27281-9999
Country	:	US
Telephone Number	:	877-472-2302
Fax Number	:	877-472-2302

Authorized Official
Title or Position	:	BILLING AND ENROLLMENT SPEC.
Name	:	APRIL PARKER
Credential	:
Telephone Number	:	850-512-9166

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	08/13/2024

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