Provider Demographics
NPI:1942200852
Name:MRC CORNERSTONE
Entity Type:Organization
Organization Name:MRC CORNERSTONE
Other - Org Name:CORNERSTONE RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-210-0138
Mailing Address - Street 1:1440 LAKE FRONT CIRCLE SUITE 140
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:281-210-0138
Mailing Address - Fax:281-292-6360
Practice Address - Street 1:4100 MOORES LN
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5102
Practice Address - Country:US
Practice Address - Phone:903-831-2968
Practice Address - Fax:903-832-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113743313M00000X, 314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001025701Medicaid
TX001025701Medicaid