Healthcare Provider Details

I. General information

NPI: 1912175159
Provider Name (Legal Business Name): CORNERSTONE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 CHANEY CT # 672
CRESTHILL IL
60403
US

IV. Provider business mailing address

670 CHANEY CT # 672
CRESTHILL IL
60403-2494
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-7045
  • Fax:
Mailing address:
  • Phone: 815-741-7045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN STORTZ
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 815-741-7042