Provider Demographics
NPI:1740217256
Name:CORNERSTONE HOME HEALTH, INC.
Entity Type:Organization
Organization Name:CORNERSTONE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BALINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:405-354-5454
Mailing Address - Street 1:3701 N MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2817
Mailing Address - Country:US
Mailing Address - Phone:405-354-5454
Mailing Address - Fax:405-942-1555
Practice Address - Street 1:8370 NW 39TH EXPY
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3011
Practice Address - Country:US
Practice Address - Phone:405-354-5454
Practice Address - Fax:405-942-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7759251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200134590AMedicaid