Provider Demographics
NPI:1700291705
Name:CORNER PIECE LLC
Entity Type:Organization
Organization Name:CORNER PIECE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-383-6914
Mailing Address - Street 1:9420 WORTHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-5756
Mailing Address - Country:US
Mailing Address - Phone:571-336-2221
Mailing Address - Fax:571-522-2705
Practice Address - Street 1:9420 WORTHINGTON DR
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-5756
Practice Address - Country:US
Practice Address - Phone:571-336-2221
Practice Address - Fax:571-522-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000112251C00000X, 251S00000X, 252Y00000X, 253Z00000X
VA0134000045251C00000X, 251S00000X, 252Y00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0133000480OtherVIRGINIA BOARD OF MEDICINE
VA0133000112OtherBCBA
VA0134000045OtherBCABA