Provider Demographics
NPI:1407986110
Name:CORNERSTONE ASSISTED LIVING INC.
Entity Type:Organization
Organization Name:CORNERSTONE ASSISTED LIVING INC.
Other - Org Name:ASCENSION LIVING VIA CHRISTI VILLAGE RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-729-3585
Mailing Address - Street 1:3636 N RIDGE RD
Mailing Address - Street 2:#400
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1213
Mailing Address - Country:US
Mailing Address - Phone:316-462-3636
Mailing Address - Fax:316-462-3676
Practice Address - Street 1:3636 N RIDGE RD
Practice Address - Street 2:#400
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1213
Practice Address - Country:US
Practice Address - Phone:316-462-3636
Practice Address - Fax:316-462-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN087057310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100390190CMedicaid
KS100390190BMedicaid
KS100390190CMedicaid