Provider Demographics
NPI:1447562434
Name:CORNERSTONE AUTISM CENTER
Entity Type:Organization
Organization Name:CORNERSTONE AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:IDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-797-8580
Mailing Address - Street 1:360 POLK ST.
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143
Mailing Address - Country:US
Mailing Address - Phone:317-888-1557
Mailing Address - Fax:317-888-1571
Practice Address - Street 1:360 POLK ST.
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143
Practice Address - Country:US
Practice Address - Phone:317-888-1557
Practice Address - Fax:317-888-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency