The Cornerstone Recovery Systems, Inc.

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

450006BN Issued in CA

Legal business name

THE CORNERSTONE RECOVERY SYSTEMS, INC.

Practice address

2096 Cascade Blvd
Shasta Lake, CA 96019-9308

Phone

(530) 275-5622

Fax

(530) 275-5226

NPI assigned

Dec 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Leo Frank Graham

Title

Executive Director

Phone

(530) 275-5622

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093883555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71012",
            "city": "SHASTA LAKE",
            "state": "CA",
            "postal_code": "960791012",
            "telephone_number": "530-275-5622",
            "fax_number": "530-275-5226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2096 CASCADE BLVD",
            "city": "SHASTA LAKE",
            "state": "CA",
            "postal_code": "960199308",
            "telephone_number": "530-275-5622",
            "fax_number": "530-275-5226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CORNERSTONE RECOVERY SYSTEMS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "LEO",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "530-275-5622",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "450006AN",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "450006BN",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADP LICENSE",
            "identifier": "450006AN",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADP LICENSE",
            "identifier": "450006BN",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Shasta Lake, CA
• Providers in Shasta Lake, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.