Basic Information
| Provider Information | |||||||||
| NPI: | 1962534057 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CORNERSTONE HEALTH CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CORNERSTONE BEHAVIORAL MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 WESTCHESTER DRIVE | ||||||||
| Address2: | SUITE 850 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022536 | ||||||||
| FaxNumber: | 3368022534 | ||||||||
| Practice Location | |||||||||
| Address1: | 1814 WESTCHESTER DR | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022205 | ||||||||
| FaxNumber: | 3368022206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 05/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | HILL | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS SERVICES OPERATIONS OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 3368022536 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103T00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 6005315 | 05 | NC | MEDICAID | 013U5 | 01 | NC | BCBS | OTHER | 6000328 | 05 | NC | MEDICAID | 6006959 | 05 | NC | MEDICAID | CC4241 | 01 | NC | RR MEDICARE | OTHER | CC4243 | 01 | NC | RR MEDICARE | OTHER | 6008013 | 05 | NC | MEDICAID | 7137437 | 01 | NC | AETNA | OTHER | A0402 | 01 | NC | MEDCOST | OTHER | CB8658 | 01 | NC | RR MEDICARE | OTHER | CD6614 | 01 | NC | RR MEDICARE | OTHER |