Provider Demographics
NPI:1497075816
Name:CORNERSTONE CARE/MOBILE UNIT
Entity Type:Organization
Organization Name:CORNERSTONE CARE/MOBILE UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MTJOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-943-3308
Mailing Address - Street 1:7 GLASSWORKS RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:15338-9507
Mailing Address - Country:US
Mailing Address - Phone:724-943-3308
Mailing Address - Fax:724-943-3310
Practice Address - Street 1:104 FRONT STREET
Practice Address - Street 2:SUITE VAN ONE
Practice Address - City:MT. MORRIS
Practice Address - State:PA
Practice Address - Zip Code:15349
Practice Address - Country:US
Practice Address - Phone:724-324-9006
Practice Address - Fax:724-324-9005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001975168-0003Medicaid