Provider Demographics
NPI:1245218718
Name:CORNERSTONE HEALTH CARE OF DOUGLAS, INC.
Entity Type:Organization
Organization Name:CORNERSTONE HEALTH CARE OF DOUGLAS, INC.
Other - Org Name:DOUGLAS NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-859-2773
Mailing Address - Street 1:2084 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-3515
Mailing Address - Country:US
Mailing Address - Phone:731-686-8321
Mailing Address - Fax:731-686-7382
Practice Address - Street 1:2084 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3515
Practice Address - Country:US
Practice Address - Phone:731-686-8321
Practice Address - Fax:731-686-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0445434Medicaid
TN7440055OtherICF MEDICAID
TN7440055OtherICF MEDICAID