Healthcare Provider Details

I. General information

NPI: 1316631484
Provider Name (Legal Business Name): CORNERSTONE AL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5554 E CAMPO BELLO DR
SCOTTSDALE AZ
85254-5847
US

IV. Provider business mailing address

5554 E CAMPO BELLO DR
SCOTTSDALE AZ
85254-5847
US

V. Phone/Fax

Practice location:
  • Phone: 602-550-4141
  • Fax:
Mailing address:
  • Phone: 602-550-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: GINGER BOGNAR
Title or Position: MANAGER
Credential:
Phone: 602-550-4141