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General NPI Number Information
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NPI Number | 1821442021
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Entity Type | Organization
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Legal Business Name | CORNERSTONE DISTRICT 3 LLC
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 484 SW COMMERCE DR STE 130
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City | LAKE CITY
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State | FL
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Zip | 32025-1588
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Country | US
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Telephone | 386-344-6935
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Fax |
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Provider Business Mailing Address
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Address Line | 484 SW COMMERCE DR STE 130
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City | LAKE CITY
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State | FL
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Zip | 32025-1588
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | TERESA RAGLAND
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Credential |
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Telephone | 386-362-8552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | FL
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