Healthcare Provider Details

I. General information

NPI: 1639003031
Provider Name (Legal Business Name): CORNERSTONE GUARDIANSHIP SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70095 GREEN PASTURES RD
STURGIS MI
49091-9736
US

IV. Provider business mailing address

PO BOX 112
PORTAGE MI
49081-0112
US

V. Phone/Fax

Practice location:
  • Phone: 269-220-4313
  • Fax: 269-864-6000
Mailing address:
  • Phone: 269-220-4313
  • Fax: 269-864-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: WILL H SMITH
Title or Position: GUARDIAN
Credential:
Phone: 269-220-4313