Healthcare Provider Details

I. General information

NPI: 1871594705
Provider Name (Legal Business Name): CORNERSTONE HOSPICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 E COOLEY DR SUITE 220
COLTON CA
92324-3921
US

IV. Provider business mailing address

1461 E COOLEY DR SUITE 220
COLTON CA
92324-3921
US

V. Phone/Fax

Practice location:
  • Phone: 909-872-8100
  • Fax: 909-872-8106
Mailing address:
  • Phone: 909-872-8100
  • Fax: 909-872-8106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. BLAINE WHITSON
Title or Position: ADMINISTRATOR
Credential: MSW
Phone: 909-872-8100