MEDICARE: CORNERSTONE HOSPICE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1043988553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE HOSPICE INC

Provider Business Mailing Address
First Line	:	4600 E WASHINGTON ST STE 300-374
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1903
Country	:	US
Telephone Number	:	480-666-3964
Fax Number	:	480-885-2592

Provider Business Practice Location Address
First Line	:	4600 E WASHINGTON ST STE 300-374
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1903
Country	:	US
Telephone Number	:	480-666-3964
Fax Number	:	480-885-2592

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DANTE BAUTISTA
Credential	:
Telephone Number	:	480-666-3964

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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