1427493451 NPI number — CORNERSTONE HEALTH CARE PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427493451 NPI number — CORNERSTONE HEALTH CARE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE HEALTH CARE PA
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:
Provider Other Organization Name Type Code:
6
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:
1427493451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 WESTCHESTER DRIVE
Provider Second Line Business Mailing Address:
SUITE 850
Provider Business Mailing Address City Name:
HIGH POINT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27262-7524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-802-2536
Provider Business Mailing Address Fax Number:
336-802-2534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4515 PREMIER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27265-8350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-802-2536
Provider Business Practice Location Address Fax Number:
336-802-2534
Provider Enumeration Date:
05/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RICHE
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS SERVICES DIRECTOR
Authorized Official Telephone Number:
336-802-2347

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5913178 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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