Healthcare Provider Details

I. General information

NPI: 1245059815
Provider Name (Legal Business Name): CORNERSTONE COMPASSIONATE CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 E BUSINESS LOOP 70 FL 2D
COLUMBIA MO
65201-4600
US

IV. Provider business mailing address

1121 E BUSINESS LOOP 70 FL 2D
COLUMBIA MO
65201-4600
US

V. Phone/Fax

Practice location:
  • Phone: 573-801-4376
  • Fax:
Mailing address:
  • Phone: 573-801-4376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KATINA ALLEN
Title or Position: CEO
Credential:
Phone: 573-801-4376