Provider Demographics
NPI:1043264278
Name:CORNERSTONE HOSPITAL OF SOUTHEAST ARIZONA LLC
Entity Type:Organization
Organization Name:CORNERSTONE HOSPITAL OF SOUTHEAST ARIZONA LLC
Other - Org Name:CORNERSTONE HOSPITAL OF SOUTHEAST ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTRAL BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-621-6716
Mailing Address - Street 1:2200 ROSS AVE
Mailing Address - Street 2:SUITE 5400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-7918
Mailing Address - Country:US
Mailing Address - Phone:469-621-6700
Mailing Address - Fax:469-621-6672
Practice Address - Street 1:7220 E ROSEWOOD ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1350
Practice Address - Country:US
Practice Address - Phone:520-546-4595
Practice Address - Fax:520-290-1465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSH-3843282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ004042Medicaid
AZ032004Medicare Oscar/Certification