Provider Demographics
NPI:1992194757
Name:CORNERSTONE COTTAGE INC
Entity Type:Organization
Organization Name:CORNERSTONE COTTAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:509-671-1729
Mailing Address - Street 1:12128 N DIVISION ST
Mailing Address - Street 2:PMB #236
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1905
Mailing Address - Country:US
Mailing Address - Phone:509-671-6274
Mailing Address - Fax:
Practice Address - Street 1:12322 N RUBY RD
Practice Address - Street 2:PMB #236
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-3606
Practice Address - Country:US
Practice Address - Phone:509-671-6274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA751079311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home