Healthcare Provider Details

I. General information

NPI: 1174176796
Provider Name (Legal Business Name): CORNERSTONE COORDINATED HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 CENTRE ST
ASHLAND PA
17921-1015
US

IV. Provider business mailing address

40 W FRACK ST
FRACKVILLE PA
17931-1719
US

V. Phone/Fax

Practice location:
  • Phone: 570-794-6123
  • Fax:
Mailing address:
  • Phone: 570-794-6123
  • Fax: 570-794-6124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES C GREENFIELD
Title or Position: OWNER
Credential:
Phone: 570-794-6123