Healthcare Provider Details

I. General information

NPI: 1225036262
Provider Name (Legal Business Name): CORNERSTONE HEALTHCARE OF ILLINOIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PLUM ST
CARMI IL
62821-1751
US

IV. Provider business mailing address

400 PLUM ST
CARMI IL
62821-1751
US

V. Phone/Fax

Practice location:
  • Phone: 618-382-4171
  • Fax: 618-382-3628
Mailing address:
  • Phone: 618-382-4171
  • Fax: 618-382-3628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0005108
License Number StateIL

VIII. Authorized Official

Name: MR. JAMES R. CHEEK
Title or Position: CEO
Credential:
Phone: 618-382-4171