Provider Demographics
NPI:1831177252
Name:CORNERSTONE HEALTH CARE OF PALMYRA, INC.
Entity type:Organization
Organization Name:CORNERSTONE HEALTH CARE OF PALMYRA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-467-6649
Mailing Address - Street 1:2727 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:TN
Mailing Address - Zip Code:37142-2051
Mailing Address - Country:US
Mailing Address - Phone:931-326-5252
Mailing Address - Fax:931-326-5585
Practice Address - Street 1:2727 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:TN
Practice Address - Zip Code:37142-2051
Practice Address - Country:US
Practice Address - Phone:931-326-5252
Practice Address - Fax:931-326-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN192313M00000X, 315P00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440300OtherICF MEDICAID
TN7447034OtherNEW DAWN ICF MEDICAID
TN0445184Medicaid
TN445184Medicare Oscar/Certification