Provider Demographics
NPI:1376684332
Name:CORNWALL HEALTH SYSTEMS, INC
Entity Type:Organization
Organization Name:CORNWALL HEALTH SYSTEMS, INC
Other - Org Name:ALTERNATE HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:OPHELIA
Authorized Official - Last Name:CALLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:623-974-8300
Mailing Address - Street 1:4229 N 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-2332
Mailing Address - Country:US
Mailing Address - Phone:623-974-8300
Mailing Address - Fax:623-974-8322
Practice Address - Street 1:4229 N 82ND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-2332
Practice Address - Country:US
Practice Address - Phone:623-974-8300
Practice Address - Fax:623-974-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ869696Medicaid