Provider Demographics
NPI:1285969279
Name:CORNERSTONE TREATMENT FACILITY, INC.
Entity type:Organization
Organization Name:CORNERSTONE TREATMENT FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-733-0617
Mailing Address - Street 1:733 BARGAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-3494
Mailing Address - Country:US
Mailing Address - Phone:877-472-2302
Mailing Address - Fax:877-472-2302
Practice Address - Street 1:129 WALLACE RD
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2434
Practice Address - Country:US
Practice Address - Phone:704-695-0601
Practice Address - Fax:704-695-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404556Medicaid