Provider Demographics
NPI:1962483594
Name:CORNERSTONE HOSPICE OF WEST CENTRAL
Entity Type:Organization
Organization Name:CORNERSTONE HOSPICE OF WEST CENTRAL
Other - Org Name:CORNERSTONE HOME HEALTH & HOSPICE CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:UPDEGRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-357-4111
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:614-357-4111
Mailing Address - Fax:937-525-8317
Practice Address - Street 1:514 HIGH STREET
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068
Practice Address - Country:US
Practice Address - Phone:937-207-2493
Practice Address - Fax:937-484-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0131HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2287618Medicaid
361611Medicare ID - Type UnspecifiedHOSPICE