Basic Information
| Provider Information | |||||||||
| NPI: | 1487998126 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CORNERSTONE HEALTH CARE, LLC | ||||||||
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| OtherOrganizationName: | CORNERSTONE BEHAVIORAL MEDICINE PERSONALIZED PRIMARY CARE AT PREMIER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 WESTCHESTER DR | ||||||||
| Address2: | SUITE 850 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022536 | ||||||||
| FaxNumber: | 3368022534 | ||||||||
| Practice Location | |||||||||
| Address1: | 4515 PREMIER DR | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272658357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022205 | ||||||||
| FaxNumber: | 3368022206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2012 | ||||||||
| LastUpdateDate: | 02/16/2017 | ||||||||
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| AuthorizedOfficialLastName: | MATHIS | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | DOUGLAS | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF ADMINISTRATIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3368022536 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
No ID Information.