Healthcare Provider Details

I. General information

NPI: 1821076373
Provider Name (Legal Business Name): CORNERSTONE HEALTH CARE OF BOLIVAR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N WATER ST
BOLIVAR TN
38008-2341
US

IV. Provider business mailing address

214 N WATER ST
BOLIVAR TN
38008-2341
US

V. Phone/Fax

Practice location:
  • Phone: 731-658-5287
  • Fax: 731-658-6359
Mailing address:
  • Phone: 731-658-5287
  • Fax: 731-658-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number116
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number116
License Number StateTN

VIII. Authorized Official

Name: CYNTHIA J MILENSKI
Title or Position: PRESIDENT
Credential:
Phone: 919-859-2773