Provider Demographics
NPI:1013344993
Name:CORNERSTONE SUPPORTS, LLC
Entity Type:Organization
Organization Name:CORNERSTONE SUPPORTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VERMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-777-9044
Mailing Address - Street 1:1905 E 152ND ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2932
Mailing Address - Country:US
Mailing Address - Phone:913-777-9044
Mailing Address - Fax:913-829-0552
Practice Address - Street 1:15909 S LINDENWOOD DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-4021
Practice Address - Country:US
Practice Address - Phone:913-777-9044
Practice Address - Fax:913-829-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200970490AOtherSTATE OF KANSAS