Healthcare Provider Details

I. General information

NPI: 1780665729
Provider Name (Legal Business Name): CORNERSTONE HOME HEALTH OF NORTH WEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 WEST NATIONAL ROAD
SPRINGFIELD OH
45504
US

IV. Provider business mailing address

2655 WEST NATIONAL ROAD
SPRINGFIELD OH
45504
US

V. Phone/Fax

Practice location:
  • Phone: 937-525-4951
  • Fax: 937-525-4951
Mailing address:
  • Phone: 937-525-4951
  • Fax: 937-525-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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