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General NPI Number Information
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NPI Number | 1689851016
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Entity Type | Organization
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Legal Business Name | CORNERSTONE COMMUNITY LIVING INC.
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 5918 HAVENWOODS DR
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City | HOUSTON
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State | TX
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Zip | 77066-2335
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Country | US
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Telephone | 281-687-2173
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Fax | 281-580-4962
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Provider Business Mailing Address
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Address Line | 5918 HAVENWOODS DR
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City | HOUSTON
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State | TX
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Zip | 77066-2335
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Country | US
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Telephone | 281-687-2173
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Fax | 281-580-4962
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Authorized Official
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Title or Position | DIRECTOR PROGRAM MANAGER
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Name | MR. SPENCER ELIJAH JACKSON JR.
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Credential | PROVIDER
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Telephone | 281-687-2173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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