Healthcare Provider Details

I. General information

NPI: 1639851934
Provider Name (Legal Business Name): CORNERSTONE CASE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CORNELL DRIVE SE #4614
ALBUQUERQUE NM
87196-4614
US

IV. Provider business mailing address

PO BOX 4614
ALBUQUERQUE NM
87196-4614
US

V. Phone/Fax

Practice location:
  • Phone: 505-417-1613
  • Fax: 505-501-8458
Mailing address:
  • Phone: 505-417-1613
  • Fax: 505-501-8458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: LORIESSA I RANDLE
Title or Position: CO-OWNER
Credential:
Phone: 505-416-1613