MEDICARE: CORNERSTONE COMMUNITY YOUTH ORGANIZATION

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1376485011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE COMMUNITY YOUTH ORGANIZATION

Provider Business Mailing Address
First Line	:	10795 MEAD RD APT 1502
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2191
Country	:	US
Telephone Number	:	985-788-7909
Fax Number	:	985-788-7909

Provider Business Practice Location Address
First Line	:	10795 MEAD RD APT 1502
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2191
Country	:	US
Telephone Number	:	985-788-7909
Fax Number	:	985-788-7909

Authorized Official
Title or Position	:	EXECUTIVE DIRCECTOR
Name	:	KEISHA HILL
Credential	:	HILL
Telephone Number	:	985-788-7909

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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