Healthcare Provider Details

I. General information

NPI: 1831997386
Provider Name (Legal Business Name): CORNERSTONE COMMUNITY OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 N CLIFTON AVE
CHICAGO IL
60640-5013
US

IV. Provider business mailing address

4615 N CLIFTON AVE
CHICAGO IL
60640-5013
US

V. Phone/Fax

Practice location:
  • Phone: 773-506-6396
  • Fax:
Mailing address:
  • Phone: 773-506-6396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW WINTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-858-0497