=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740192103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORNERSTONE CARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2026
-----------------------------------------------------
Last Update Date | 09/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2184 9TH AVE S
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33712-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-492-9651
-----------------------------------------------------
Fax | 813-936-6032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16647 MYRTLE SAND DR
-----------------------------------------------------
City | WIMAUMA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33598-4070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-492-9651
-----------------------------------------------------
Fax | 813-936-6032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EUGENIA CASON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-492-9651
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------