Provider Demographics
NPI:1720495161
Name:CORNERSTONE FAMILY CARE, LLC
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY CARE, LLC
Other - Org Name:CORNERSTONE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LAWSON
Authorized Official - Last Name:GWYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-349-3610
Mailing Address - Street 1:PO BOX 2361
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27323-2361
Mailing Address - Country:US
Mailing Address - Phone:336-349-3610
Mailing Address - Fax:336-342-4473
Practice Address - Street 1:424 GLOVENIA ST
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-4844
Practice Address - Country:US
Practice Address - Phone:336-349-3610
Practice Address - Fax:336-342-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL079097310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility