Provider Demographics
NPI:1619225778
Name:CORNERSTONE HEALTH CARE, LLC
Entity Type:Organization
Organization Name:CORNERSTONE HEALTH CARE, LLC
Other - Org Name:CORNERSTONE CARE OUTREACH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-802-2536
Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2536
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:1208 EASTCHESTER DR
Practice Address - Street 2:SUITE 107A
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3170
Practice Address - Country:US
Practice Address - Phone:336-802-2291
Practice Address - Fax:336-802-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty