Provider Demographics
NPI:1780665729
Name:CORNERSTONE HOME HEALTH OF NORTH WEST
Entity Type:Organization
Organization Name:CORNERSTONE HOME HEALTH OF NORTH WEST
Other - Org Name:CORNERSTONE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:UPDEGRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-357-4111
Mailing Address - Street 1:2655 WEST NATIONAL ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504
Mailing Address - Country:US
Mailing Address - Phone:937-525-4951
Mailing Address - Fax:937-525-4980
Practice Address - Street 1:2655 WEST NATIONAL ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504
Practice Address - Country:US
Practice Address - Phone:937-525-4951
Practice Address - Fax:937-525-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2208051Medicaid
OH2287618Medicaid
OH367772Medicare PIN
OH2208051Medicaid