Healthcare Provider Details

I. General information

NPI: 1730201054
Provider Name (Legal Business Name): CORNERSTONE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 MCHENRY AVE
WOODSTOCK IL
60098-2922
US

IV. Provider business mailing address

645 MCHENRY AVE
WOODSTOCK IL
60098-2922
US

V. Phone/Fax

Practice location:
  • Phone: 815-334-0411
  • Fax: 815-334-0413
Mailing address:
  • Phone: 815-334-0411
  • Fax: 815-334-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name: SUSAN ANN KLOUDA
Title or Position: GENERAL PARTNER
Credential: LCSW
Phone: 815-334-0411