Healthcare Provider Details

I. General information

NPI: 1720447212
Provider Name (Legal Business Name): CORNERSTONES OF CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 WORNALL RD
KANSAS CITY MO
64114-5806
US

IV. Provider business mailing address

8150 WORNALL RD
KANSAS CITY MO
64114-5806
US

V. Phone/Fax

Practice location:
  • Phone: 816-508-3500
  • Fax: 816-508-3535
Mailing address:
  • Phone: 816-508-3500
  • Fax: 816-508-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number001912014
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number001912014
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001912014
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001912014
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number001912014
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number001912014
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001912014
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 10
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. TABITHA DAVIDSON-JADWIN
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 816-508-3500