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General NPI Number Information
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NPI Number | 1639851934
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Entity Type | Organization
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Legal Business Name | CORNERSTONE CASE MANAGEMENT LLC
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 115 CORNELL DRIVE SE #4614
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City | ALBUQUERQUE
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State | NM
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Zip | 87196-4614
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Country | US
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Telephone | 505-417-1613
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Fax | 505-501-8458
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Provider Business Mailing Address
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Address Line | PO BOX 4614
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City | ALBUQUERQUE
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State | NM
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Zip | 87196-4614
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Country | US
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Telephone | 505-417-1613
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Fax | 505-501-8458
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Authorized Official
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Title or Position | CO-OWNER
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Name | LORIESSA I RANDLE
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Credential |
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Telephone | 505-416-1613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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