Healthcare Provider Details

I. General information

NPI: 1235184375
Provider Name (Legal Business Name): CORNERSTONE HOME HEALTH OF NORTH EAST OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 SOUTH AVE SUITE #4
BOARDMAN OH
44512
US

IV. Provider business mailing address

2655 WEST NATIONAL ROAD
SPRINGFIELD OH
45504
US

V. Phone/Fax

Practice location:
  • Phone: 330-782-8850
  • Fax: 330-782-8860
Mailing address:
  • Phone: 937-325-1531
  • Fax: 937-525-8317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberNONE REQUIRED
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSICA L UPDEGRAFF
Title or Position: PRESIDENT
Credential: RN
Phone: 614-357-4111