Provider Demographics
NPI:1083919591
Name:CORNERSTONE LIVING CENTER OF WINSTON-SALEM
Entity Type:Organization
Organization Name:CORNERSTONE LIVING CENTER OF WINSTON-SALEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMRIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-397-2662
Mailing Address - Street 1:2900 REYNOLDS PARK RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-1653
Mailing Address - Country:US
Mailing Address - Phone:336-397-2662
Mailing Address - Fax:336-397-2666
Practice Address - Street 1:2900 REYNOLDS PARK RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1653
Practice Address - Country:US
Practice Address - Phone:336-397-2662
Practice Address - Fax:336-397-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-034-0913104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances