Provider Demographics
NPI:1235420852
Name:CORNERSTONE HEALTH SERVICES, INC-
Entity Type:Organization
Organization Name:CORNERSTONE HEALTH SERVICES, INC-
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-471-7320
Mailing Address - Street 1:512 COTTAGE PL
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2408
Mailing Address - Country:US
Mailing Address - Phone:770-471-7320
Mailing Address - Fax:770-471-9057
Practice Address - Street 1:512 COTTAGE PL
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2408
Practice Address - Country:US
Practice Address - Phone:770-471-7320
Practice Address - Fax:770-471-9057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-30
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031011501261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities