MEDICARE: CORNERSTONE COURT LLC

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	310400000X	Assisted Living Facility	2243	WA

General Provider Information

NPI Number	:	1790174548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE COURT LLC

Provider Business Mailing Address
First Line	:	12128 N DIVISION ST
Second Line	:	PMB 236
City	:	SPOKANE
State	:	WA
Zip	:	99218-1905
Country	:	US
Telephone Number	:	509-671-1729
Fax Number	:	506-466-2819

Provider Business Practice Location Address
First Line	:	12128 N DIVISION ST
Second Line	:	PMB 236
City	:	SPOKANE
State	:	WA
Zip	:	99218-1905
Country	:	US
Telephone Number	:	509-671-1729
Fax Number	:	506-466-2819

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CYNTHIA DAWN ROGERS
Credential	:	RN
Telephone Number	:	509-671-1729

Provider Enumeration Date	:	01/16/2015
Last Update Date	:	01/16/2015

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