Provider Demographics
NPI:1063501401
Name:CORNERSTONE HOSPICE PALLIATIVE CARE, LLC
Entity Type:Organization
Organization Name:CORNERSTONE HOSPICE PALLIATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-890-7230
Mailing Address - Street 1:6229 HIGHWAY 305 N
Mailing Address - Street 2:SUITE D
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-3082
Mailing Address - Country:US
Mailing Address - Phone:662-890-7230
Mailing Address - Fax:662-890-7241
Practice Address - Street 1:6229 HIGHWAY 305 N
Practice Address - Street 2:SUITE D
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3082
Practice Address - Country:US
Practice Address - Phone:662-890-7230
Practice Address - Fax:662-890-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06008241Medicaid
MS251642Medicare Oscar/Certification