NPIMap

Organization Active NPI

Cornerstone Healing Center, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Phoenix, AZ
National Provider Identifier
1649958760
Registry record updated Dec 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CORNERSTONE HEALING CENTER, LLC
Practice address
4344 W Indian School Rd Ste 22And23
Phoenix, AZ 85031-2984
Phone
(800) 480-1781
Fax
(480) 590-7303
NPI assigned
Jul 10, 2023
Last updated
Dec 11, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CORNERSTONE HEALING CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 11, 2023

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

Authorized official

Name
Estil Wallace
Title
Ceo
Phone
(602) 544-6832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

4344 W Indian School Rd Ste 22And23
Phoenix, AZ 85031-2984

Mailing address

4344 W Indian School Rd Ste 22
Phoenix, AZ 85031-2985

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2286573Cornerstone Healing Center LLC4344 W Indian School Rd Ste 22/23, Phoenix, AZ 85031Certificate of waiverJul 31, 2027

National Provider Directory

National Provider Directory
Part of
Cornerstone Healing Center

Locations

4344 W Indian School Rd
Ste 22AND23
Phoenix, AZ 85031
Phone (800) 480-1781

16444 N 91st St
Scottsdale, AZ 85260
Phone (480) 863-0217

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702252800000",
    "number": "1649958760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4344 W INDIAN SCHOOL RD STE 22",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850312985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4344 W INDIAN SCHOOL RD STE 22AND23",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850312984",
            "telephone_number": "800-480-1781",
            "fax_number": "480-590-7303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE HEALING CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CORNERSTONE HEALING CENTER, LLC",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "ESTIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-544-6832"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.