Provider Demographics
NPI:1356975767
Name:CORNERSTONE COMMUNITY SERVICE
Entity type:Organization
Organization Name:CORNERSTONE COMMUNITY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:919-630-7103
Mailing Address - Street 1:716 CROSBY RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1705
Mailing Address - Country:US
Mailing Address - Phone:919-630-7103
Mailing Address - Fax:
Practice Address - Street 1:2220 SOUTHGATE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-2102
Practice Address - Country:US
Practice Address - Phone:919-630-7103
Practice Address - Fax:919-794-8390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home