Provider Demographics
NPI:1750406989
Name:CORNERSTONE HEALTH CARE, PA
Entity type:Organization
Organization Name:CORNERSTONE HEALTH CARE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-802-2400
Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2536
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:4515 PREMIER DRIVE
Practice Address - Street 2:SUITE 402
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8356
Practice Address - Country:US
Practice Address - Phone:336-802-2210
Practice Address - Fax:336-802-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB0216OtherMEDCOST
NCD266OtherPARTNERS
NC7765735OtherAETNA
NCCD6614OtherRR MEDICARE
NCCC4243OtherRR MEDICARE
NCCD8658OtherRR MEDICARE
NC89016FXMedicaid
NCCC4241OtherRR MEDICARE
NC016FXOtherBCBS
NCD266OtherPARTNERS
NC016FXOtherBCBS
NCCC4243OtherRR MEDICARE