Provider Demographics
NPI:1255227286
Name:CORNERSTONE RESIDENCE OF OKLEE LLC
Entity type:Organization
Organization Name:CORNERSTONE RESIDENCE OF OKLEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-435-6205
Mailing Address - Street 1:114 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-1302
Mailing Address - Country:US
Mailing Address - Phone:218-435-6205
Mailing Address - Fax:218-435-6336
Practice Address - Street 1:306 TOUPIN ST
Practice Address - Street 2:
Practice Address - City:OKLEE
Practice Address - State:MN
Practice Address - Zip Code:56742-4222
Practice Address - Country:US
Practice Address - Phone:218-435-6205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility