Provider Demographics
NPI:1558479758
Name:CORNERSTONE OF RECOVERY
Entity type:Organization
Organization Name:CORNERSTONE OF RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-244-8112
Mailing Address - Street 1:4726 AIRPORT HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-5402
Mailing Address - Country:US
Mailing Address - Phone:865-970-7747
Mailing Address - Fax:865-681-2266
Practice Address - Street 1:4718 ALCOA HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:TN
Practice Address - Zip Code:37777-5402
Practice Address - Country:US
Practice Address - Phone:865-970-7747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN100000002973324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ009122Medicaid
TNL000000008360OtherDEPARTMENT OF MENTAL HEALTH
OH12833OtherOHIO DEPARTMENT OF ALCOHOL AND DRUG ADDICTION SERVICES
TNL000000008359OtherDEPARTMENT OF MENTAL HEALTH
TNL000000008361OtherDEPARTMENT OF MENTAL HEALTH
TNL000000008362OtherDEPARTMENT OF MENTAL HEALTH
TN1000000010585OtherDEPARTMENT OF HEALTH
TN1000000010583OtherDEPARTMENT OF MENTAL HEALTH