Provider Demographics
NPI:1083644744
Name:CORNERSTONE CARE, INC.
Entity Type:Organization
Organization Name:CORNERSTONE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MT.JOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-943-3308
Mailing Address - Street 1:PO BOX 440
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15359-0440
Mailing Address - Country:US
Mailing Address - Phone:724-499-5188
Mailing Address - Fax:724-499-5847
Practice Address - Street 1:140 CHURCH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ROGERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15359-1001
Practice Address - Country:US
Practice Address - Phone:724-499-5188
Practice Address - Fax:724-499-5847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100772557-0004Medicaid
PA033344Medicare PIN
PA391806Medicare Oscar/Certification