Provider Demographics
NPI:1225036262
Name:CORNERSTONE HEALTHCARE OF ILLINOIS, INC.
Entity Type:Organization
Organization Name:CORNERSTONE HEALTHCARE OF ILLINOIS, INC.
Other - Org Name:WHITE COUNTY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-382-4171
Mailing Address - Street 1:400 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-1751
Mailing Address - Country:US
Mailing Address - Phone:618-382-4171
Mailing Address - Fax:618-382-3628
Practice Address - Street 1:400 PLUM ST
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1751
Practice Address - Country:US
Practice Address - Phone:618-382-4171
Practice Address - Fax:618-382-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005108282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL141314Medicare ID - Type Unspecified