Provider Demographics
NPI:1780993964
Name:THE CORNERSTONE OF STURGEON BAY
Entity type:Organization
Organization Name:THE CORNERSTONE OF STURGEON BAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWLETT-DESPOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-746-7550
Mailing Address - Street 1:204 N DULUTH AVE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-2922
Mailing Address - Country:US
Mailing Address - Phone:920-746-7550
Mailing Address - Fax:920-746-7551
Practice Address - Street 1:204 N DULUTH AVE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2922
Practice Address - Country:US
Practice Address - Phone:920-746-7550
Practice Address - Fax:920-746-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8736310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility