Healthcare Provider Details

I. General information

NPI: 1982145546
Provider Name (Legal Business Name): CORNERSTONE WELLNESS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 MONTICELLO RD
COLUMBIA SC
29203-3448
US

IV. Provider business mailing address

5010 MONTICELLO RD
COLUMBIA SC
29203-3448
US

V. Phone/Fax

Practice location:
  • Phone: 803-995-3322
  • Fax: 803-754-8889
Mailing address:
  • Phone: 803-995-3322
  • Fax: 803-754-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BISHOP
Title or Position: CEO
Credential:
Phone: 803-995-3322