Provider Demographics
NPI:1043988553
Name:CORNERSTONE HOSPICE INC
Entity Type:Organization
Organization Name:CORNERSTONE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-666-3964
Mailing Address - Street 1:4600 E WASHINGTON ST STE 300-374
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-1903
Mailing Address - Country:US
Mailing Address - Phone:480-666-3964
Mailing Address - Fax:480-885-2592
Practice Address - Street 1:4600 E WASHINGTON ST STE 300-374
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-1903
Practice Address - Country:US
Practice Address - Phone:480-666-3964
Practice Address - Fax:480-885-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based