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General NPI Number Information
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NPI Number | 1699062182
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Entity Type | Organization
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Legal Business Name | CORNERSTONE FOUNDATION
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 105 W DIVISION ST
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City | DODGEVILLE
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State | WI
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Zip | 53533-1423
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Country | US
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Telephone | 608-935-1649
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Fax | 608-935-0804
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Provider Business Mailing Address
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Address Line | 105 W DIVISION ST
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City | DODGEVILLE
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State | WI
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Zip | 53533-1423
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Country | US
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Telephone | 608-935-1649
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Fax | 608-935-0804
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Authorized Official
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Title or Position | CASE MANAGER
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Name | MS. JEAN ANN O'NEILL
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Credential |
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Telephone | 608-935-1649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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