Provider Demographics
NPI:1235184375
Name:CORNERSTONE HOME HEALTH OF NORTH EAST OHIO
Entity Type:Organization
Organization Name:CORNERSTONE HOME HEALTH OF NORTH EAST OHIO
Other - Org Name:CORNERSTONE HOME HEALTH OF NORTHEAST OHIO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:UPDEGRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-357-4111
Mailing Address - Street 1:2655 WEST NATIONAL ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504
Mailing Address - Country:US
Mailing Address - Phone:937-325-1531
Mailing Address - Fax:937-525-8317
Practice Address - Street 1:8170 SOUTH AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-782-8850
Practice Address - Fax:330-782-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNONE REQUIRED251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2719035Medicaid
368169Medicare PIN
368169Medicare Oscar/Certification