Healthcare Provider Details

I. General information

NPI: 1962857052
Provider Name (Legal Business Name): CORNERSTONE FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1748 W KATELLA AVE STE 207
ORANGE CA
92867-3430
US

IV. Provider business mailing address

1748 W KATELLA AVE STE 207
ORANGE CA
92867-3430
US

V. Phone/Fax

Practice location:
  • Phone: 714-744-3800
  • Fax:
Mailing address:
  • Phone: 714-744-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER L GAMBLE
Title or Position: MANAGING MEMBER
Credential:
Phone: 714-744-3800