Healthcare Provider Details

I. General information

NPI: 1962483594
Provider Name (Legal Business Name): CORNERSTONE HOSPICE OF WEST CENTRAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 HIGH STREET
WAYNESVILLE OH
45068
US

IV. Provider business mailing address

2655 WEST NATIONAL ROAD
SPRINGFIELD OH
45504
US

V. Phone/Fax

Practice location:
  • Phone: 937-207-2493
  • Fax: 937-484-3868
Mailing address:
  • Phone: 614-357-4111
  • Fax: 937-525-8317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0131HSP
License Number StateOH

VIII. Authorized Official

Name: JESSICA L UPDEGRAFF
Title or Position: PRESIDENT
Credential: RN
Phone: 617-357-4111