Provider Demographics
NPI:1831304799
Name:CORNER HOMECARE
Entity Type:Organization
Organization Name:CORNER HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:K
Authorized Official - Last Name:PPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-365-3903
Mailing Address - Street 1:108 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-2250
Mailing Address - Country:US
Mailing Address - Phone:270-365-3903
Mailing Address - Fax:270-365-2024
Practice Address - Street 1:108 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-2250
Practice Address - Country:US
Practice Address - Phone:270-365-3903
Practice Address - Fax:270-365-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54005178Medicaid
KY54024286Medicaid
KY90020173Medicaid
KY45902913Medicaid
KY54024286Medicaid
KY0207870002Medicare NSC