Healthcare Provider Details

I. General information

NPI: 1326494329
Provider Name (Legal Business Name): CORNERSTONE HME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6228 SIERRA DR
OLIVE BRANCH MS
38654-7964
US

IV. Provider business mailing address

6228 SIERRA DR
OLIVE BRANCH MS
38654-7964
US

V. Phone/Fax

Practice location:
  • Phone: 901-239-3194
  • Fax:
Mailing address:
  • Phone: 901-239-3194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLE GOLDEN
Title or Position: OWNER
Credential:
Phone: 901-239-3194