1508829045 NPI number — CORNERSTONE VNA

Table of content: (NPI 1508829045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508829045 NPI number — CORNERSTONE VNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE VNA
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:
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:
1508829045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
178 FARMINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03867-4352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-332-1133
Provider Business Mailing Address Fax Number:
603-335-6569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
178 FARMINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03867-4352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-332-1133
Provider Business Practice Location Address Fax Number:
603-335-6569
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REYNOLDS
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
603-332-1133

Provider Taxonomy Codes

  • Taxonomy code: 2278P3800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 02814 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 702109 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 80307025 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 307022 . This is a "ANTHEM BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 99591038 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30586249 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5561 . This is a "GENTIVA CARECENTRIX" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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