Provider Demographics
NPI:1114489556
Name:CORNERSTONE SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:CORNERSTONE SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASAUNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:864-884-7211
Mailing Address - Street 1:PO BOX 24601
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29224-4601
Mailing Address - Country:US
Mailing Address - Phone:843-619-7036
Mailing Address - Fax:843-619-7037
Practice Address - Street 1:207 QUINTON LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8520
Practice Address - Country:US
Practice Address - Phone:843-619-7036
Practice Address - Fax:843-619-7037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency