Provider Demographics
NPI:1346694957
Name:CORNERSTONE SERVICES INC
Entity Type:Organization
Organization Name:CORNERSTONE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STORTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-741-7042
Mailing Address - Street 1:800 BLACK RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5942
Mailing Address - Country:US
Mailing Address - Phone:815-741-7045
Mailing Address - Fax:
Practice Address - Street 1:800 BLACK RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5942
Practice Address - Country:US
Practice Address - Phone:815-741-7045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL058150001261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL058150001OtherLICENCE NUMBER
IL=========019Medicaid