Basic Information
| Provider Information | |||||||||
| NPI: | 1558479758 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CORNERSTONE OF RECOVERY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1214 TOPSIDE RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377775505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659707747 | ||||||||
| FaxNumber: | 8656812266 | ||||||||
| Practice Location | |||||||||
| Address1: | 1214 TOPSIDE RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377775505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659707747 | ||||||||
| FaxNumber: | 8656812266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 08/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | CALDWELL | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8659707747 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 100000002973 | TN | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
ID Information
| ID | Type | State | Issuer | Description | 1000000010584 | 01 | TN | DEPARTMENT OF MENTAL HEALTH | OTHER | L000000008360 | 01 | TN | DEPARTMENT OF MENTAL HEALTH | OTHER | 12833 | 01 | OH | OHIO DEPARTMENT OF ALCOHOL AND DRUG ADDICTION SERVICES | OTHER | L000000008359 | 01 | TN | DEPARTMENT OF MENTAL HEALTH | OTHER | L000000008361 | 01 | TN | DEPARTMENT OF MENTAL HEALTH | OTHER | L000000008362 | 01 | TN | DEPARTMENT OF MENTAL HEALTH | OTHER | 1000000010585 | 01 | TN | DEPARTMENT OF HEALTH | OTHER | 1000000010583 | 01 | TN | DEPARTMENT OF MENTAL HEALTH | OTHER |