Healthcare Provider Details

I. General information

NPI: 1124038690
Provider Name (Legal Business Name): CORNERSTONE GARDENS L L P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 MARLANDWOOD RD
TEMPLE TX
76502-3573
US

IV. Provider business mailing address

7150 GANTT ACCESS RD
AZLE TX
76020-5638
US

V. Phone/Fax

Practice location:
  • Phone: 254-771-5950
  • Fax:
Mailing address:
  • Phone: 817-444-2516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number125282
License Number StateTX

VIII. Authorized Official

Name: MAURA PANOS
Title or Position: ACCOUNTANT
Credential:
Phone: 817-444-2516