Organization
THE CORNERSTONE RECOVERY SYSTEMS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEO FRANK GRAHAM (EXECUTIVE DIRECTOR)
(530) 275-5622
Entity
Organization
Contact information
Practice address
2096 CASCADE BLVD, SHASTA LAKE, CA 96019-9308
(530) 275-5622
(530) 275-5226
Mailing address
PO BOX 71012, SHASTA LAKE, CA 96079-1012
(530) 275-5622
(530) 275-5226
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
450006AN
CA
324500000X
Substance Abuse Rehabilitation Facility
Primary
450006BN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
450006AN
ADP LICENSE
CA
01
—
450006BN
ADP LICENSE
CA
Enumeration date
12/01/2006
Last updated
08/22/2020
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