Provider Demographics
NPI:1598056905
Name:CORNERSTONE HOME CARE SERVICES
Entity Type:Organization
Organization Name:CORNERSTONE HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VAUNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:321-821-7793
Mailing Address - Street 1:2903 WEST NEW HAVEN AVE
Mailing Address - Street 2:#404
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3661
Mailing Address - Country:US
Mailing Address - Phone:321-821-7793
Mailing Address - Fax:321-821-0847
Practice Address - Street 1:95 BULLDOG BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3188
Practice Address - Country:US
Practice Address - Phone:321-821-7793
Practice Address - Fax:321-821-0847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNR30211492OtherAHCA