Provider Demographics
NPI:1730656562
Name:CORNERSTONE HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:CORNERSTONE HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA BSN RN
Authorized Official - Phone:703-474-3431
Mailing Address - Street 1:778 BALLS BLUFF RD NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4900
Mailing Address - Country:US
Mailing Address - Phone:170-347-4343
Mailing Address - Fax:
Practice Address - Street 1:778 BALLS BLUFF RD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4900
Practice Address - Country:US
Practice Address - Phone:170-347-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-191961Medicaid