Healthcare Provider Details

I. General information

NPI: 1487109328
Provider Name (Legal Business Name): CORNERSTONE ADHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2016
Last Update Date: 08/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E MAIN ST SUITE A
PARK HILLS MO
63601-2624
US

IV. Provider business mailing address

512 E MAIN ST SUITE A
PARK HILLS MO
63601-2624
US

V. Phone/Fax

Practice location:
  • Phone: 573-327-8610
  • Fax: 573-327-8611
Mailing address:
  • Phone: 573-327-8610
  • Fax: 573-327-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1351
License Number StateMO

VIII. Authorized Official

Name: MRS. SARAH REBECCA WILKINS
Title or Position: MEMBER
Credential: RN
Phone: 573-747-8550