Healthcare Provider Details

I. General information

NPI: 1770981342
Provider Name (Legal Business Name): CORNERSTONE HEALTH CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 PREMIER DR SUITE 204
HIGH POINT NC
27265-8357
US

IV. Provider business mailing address

9276 SCRANTON RD SUITE 100
SAN DIEGO CA
92121-7701
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number9300122
License Number StateNC

VIII. Authorized Official

Name: KENNY HEINE
Title or Position: VP OF OPERATIONS
Credential:
Phone: 858-964-1506