Provider Demographics
NPI:1063954469
Name:CORNERSTONE BEHAVIORAL HEALTH SERVICES INC
Entity type:Organization
Organization Name:CORNERSTONE BEHAVIORAL HEALTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREEDLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-248-7367
Mailing Address - Street 1:125 N MECKLENBURG AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-2045
Mailing Address - Country:US
Mailing Address - Phone:434-584-9845
Mailing Address - Fax:434-584-9810
Practice Address - Street 1:125 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2045
Practice Address - Country:US
Practice Address - Phone:434-584-9845
Practice Address - Fax:434-584-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1843-03-002251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health