Provider Demographics
NPI:1417571191
Name:CORNERSTONE FAMILY HEALTHCARE
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY HEALTHCARE
Other - Org Name:THE GREATER HUDSON VALLEY FAMILY HEALTH CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-220-3165
Mailing Address - Street 1:2570 ROUTE 9W STE 10
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1370
Mailing Address - Country:US
Mailing Address - Phone:845-534-2940
Mailing Address - Fax:845-534-2940
Practice Address - Street 1:14 GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4806
Practice Address - Country:US
Practice Address - Phone:845-563-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE FAMILY HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-29
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)