Provider Demographics
NPI:1376753376
Name:CORNERSTONE LIVING SKILLS
Entity Type:Organization
Organization Name:CORNERSTONE LIVING SKILLS
Other - Org Name:BAIRD HOUSE ETAL
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-579-3151
Mailing Address - Street 1:3649 W BEECHWOOD AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0693
Mailing Address - Country:US
Mailing Address - Phone:559-451-0399
Mailing Address - Fax:
Practice Address - Street 1:5302 BADGER RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-2744
Practice Address - Country:US
Practice Address - Phone:559-451-0399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80215FMedicaid