Provider Demographics
NPI:1114073368
Name:CORNERSTONE PERSONAL CARE SERVICES
Entity Type:Organization
Organization Name:CORNERSTONE PERSONAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STILLS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:423-638-9995
Mailing Address - Street 1:808 TUSCULUM BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-5123
Mailing Address - Country:US
Mailing Address - Phone:423-638-9995
Mailing Address - Fax:423-798-2820
Practice Address - Street 1:808 TUSCULUM BLVD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-5123
Practice Address - Country:US
Practice Address - Phone:423-638-9995
Practice Address - Fax:423-798-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN64504261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities