Provider Demographics
NPI:1194029819
Name:CORNERSTONE CARE INC.
Entity Type:Organization
Organization Name:CORNERSTONE CARE INC.
Other - Org Name:CORNERSTONE CARE - MT. MORRIS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MTJOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-943-3308
Mailing Address - Street 1:120 LOCUST AVENUE EXTENSION
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:PA
Mailing Address - Zip Code:15349
Mailing Address - Country:US
Mailing Address - Phone:724-324-9001
Mailing Address - Fax:724-324-9005
Practice Address - Street 1:120 LOCUST AVENUE EXTENSION
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:PA
Practice Address - Zip Code:15349
Practice Address - Country:US
Practice Address - Phone:724-324-9001
Practice Address - Fax:724-324-9005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-10
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100772557-0024Medicaid