Provider Demographics
NPI:1174647242
Name:CORNERSTONE HOME HEALTH CARE
Entity Type:Organization
Organization Name:CORNERSTONE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:ROUNTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-453-0040
Mailing Address - Street 1:PO BOX 2050
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-2050
Mailing Address - Country:US
Mailing Address - Phone:918-453-0040
Mailing Address - Fax:918-453-0220
Practice Address - Street 1:1409 S MUSKOGEE AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5267
Practice Address - Country:US
Practice Address - Phone:918-453-0040
Practice Address - Fax:918-453-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37-7623251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-7623Medicare ID - Type UnspecifiedHOME HEALTH CARE