Provider Demographics
NPI:1851566939
Name:CORNERSTONE SUPPORTED LIVING,LLC
Entity Type:Organization
Organization Name:CORNERSTONE SUPPORTED LIVING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANTILLA
Authorized Official - Middle Name:EDWARDS
Authorized Official - Last Name:BOATENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-235-8750
Mailing Address - Street 1:650 S ASHBURTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2703
Mailing Address - Country:US
Mailing Address - Phone:614-235-8750
Mailing Address - Fax:
Practice Address - Street 1:650 S ASHBURTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2703
Practice Address - Country:US
Practice Address - Phone:614-235-8750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health