Provider Demographics
NPI:1669099586
Name:CORNERSTONE CARE OPTION, INC.
Entity type:Organization
Organization Name:CORNERSTONE CARE OPTION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-761-6621
Mailing Address - Street 1:12640 SE BUSH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3423
Mailing Address - Country:US
Mailing Address - Phone:503-761-6621
Mailing Address - Fax:503-761-0861
Practice Address - Street 1:12640 SE BUSH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-3423
Practice Address - Country:US
Practice Address - Phone:503-761-6621
Practice Address - Fax:503-761-0861
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE CARE OPTION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1437180486Medicaid