Provider Demographics
NPI:1689981540
Name:CORNERSTONE TREATMENT FACILITY PROGRAM INC.
Entity type:Organization
Organization Name:CORNERSTONE TREATMENT FACILITY PROGRAM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-515-0220
Mailing Address - Street 1:703 W 3RD AVE # A
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-1524
Mailing Address - Country:US
Mailing Address - Phone:850-515-0220
Mailing Address - Fax:850-515-0260
Practice Address - Street 1:703 W 3RD AVE # A
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-1524
Practice Address - Country:US
Practice Address - Phone:850-515-0220
Practice Address - Fax:850-515-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility