Healthcare Provider Details

I. General information

NPI: 1740192103
Provider Name (Legal Business Name): CORNERSTONE CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2184 9TH AVE S
ST PETERSBURG FL
33712-2204
US

IV. Provider business mailing address

16647 MYRTLE SAND DR
WIMAUMA FL
33598-4070
US

V. Phone/Fax

Practice location:
  • Phone: 727-492-9651
  • Fax: 813-936-6032
Mailing address:
  • Phone: 727-492-9651
  • Fax: 813-936-6032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: EUGENIA CASON
Title or Position: OWNER
Credential:
Phone: 727-492-9651