Healthcare Provider Details

I. General information

NPI: 1467365833
Provider Name (Legal Business Name): CORNERSTONE COMMUNITY CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31910 MISSION TRL
LAKE ELSINORE CA
92530-4539
US

IV. Provider business mailing address

34570 MONTE VISTA DR
WILDOMAR CA
92595-8035
US

V. Phone/Fax

Practice location:
  • Phone: 951-674-8661
  • Fax:
Mailing address:
  • Phone: 951-674-8661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHN AARON CARR
Title or Position: EXECUTIVE OPERATIONS PASTOR
Credential:
Phone: 951-796-0014