1639305808 NPI number — CORNERSTONE HEALTH CARE, LLC

Table of content: (NPI 1639305808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639305808 NPI number — CORNERSTONE HEALTH CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE HEALTH CARE, LLC
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:
1639305808
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 WESTCHESTER DR
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:
27262-7254
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:
350 N COX ST
Provider Second Line Business Practice Location Address:
SUITE 20
Provider Business Practice Location Address City Name:
ASHEBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27203-5514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-672-3200
Provider Business Practice Location Address Fax Number:
336-629-7349
Provider Enumeration Date:
06/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
336-802-2400

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CB8658 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CC4241 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CC4243 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5912488 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CD6614 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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