Provider Demographics
NPI:1477068757
Name:CORNERSTONES OF MAINE INC.
Entity type:Organization
Organization Name:CORNERSTONES OF MAINE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GELLES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-225-0383
Mailing Address - Street 1:257 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2154
Mailing Address - Country:US
Mailing Address - Phone:800-588-6898
Mailing Address - Fax:
Practice Address - Street 1:257 SOUTH ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2154
Practice Address - Country:US
Practice Address - Phone:800-588-6898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness