1780665729 NPI number — CORNERSTONE HOME HEALTH OF NORTH WEST

Table of content: (NPI 1780665729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780665729 NPI number — CORNERSTONE HOME HEALTH OF NORTH WEST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE HOME HEALTH OF NORTH WEST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CORNERSTONE HOME HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780665729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2655 WEST NATIONAL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-525-4951
Provider Business Mailing Address Fax Number:
937-525-4980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2655 WEST NATIONAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-525-4951
Provider Business Practice Location Address Fax Number:
937-525-4951
Provider Enumeration Date:
11/08/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
UPDEGRAFF
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-357-4111

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2208051 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2287618 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".