Provider Demographics
NPI:1144512468
Name:CORNERSTONE TREATMENT FACILITY PROGRAM, INC.
Entity type:Organization
Organization Name:CORNERSTONE TREATMENT FACILITY PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING / ENROLLMENT SPEC
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-512-9166
Mailing Address - Street 1:2990 SUNNYSIDE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-6914
Mailing Address - Country:US
Mailing Address - Phone:850-512-9166
Mailing Address - Fax:877-472-2302
Practice Address - Street 1:778 HOFFMAN RD
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-9029
Practice Address - Country:US
Practice Address - Phone:877-472-2302
Practice Address - Fax:877-472-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1144512468Medicaid
NC3404583Medicaid