| Cornerstone Of Change, Llc | |
|
2250 Nw 136 Ave Pembroke Pines FL 33028-2586 | |
| (954) 247-4157 | |
| Not Available |
| Full Name | Cornerstone Of Change, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2250 Nw 136 Ave, Pembroke Pines, Florida |
| Authorized Official Name and Position | Tracy Oliver (MANAGER) |
| Authorized Official Contact | 9542474157 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cornerstone Of Change, Llc 5846 S Flamingo Rd # 513 Cooper City FL 33330-3237 Ph: (954) 247-4157 | Cornerstone Of Change, Llc 2250 Nw 136 Ave Pembroke Pines FL 33028-2586 Ph: (954) 247-4157 |
| NPI Number | 1053819094 |
|---|---|
| Provider Enumeration Date | 01/24/2018 |
| Last Update Date | 01/24/2018 |
| Medicare PECOS PAC ID | 6103261516 |
|---|---|
| Medicare Enrollment ID | O20240226000920 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053819094 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Tracy Oliver |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1417335977 PECOS PAC ID: 7911342324 Enrollment ID: I20240226001065 |
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