Provider Demographics
NPI:1194155010
Name:CORNERSTONE HEALTHCARE INC
Entity type:Organization
Organization Name:CORNERSTONE HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-913-7913
Mailing Address - Street 1:5292 S COLLEGE DR
Mailing Address - Street 2:304
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2991
Mailing Address - Country:US
Mailing Address - Phone:801-716-7800
Mailing Address - Fax:877-676-6599
Practice Address - Street 1:5292 S COLLEGE DR
Practice Address - Street 2:304
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2991
Practice Address - Country:US
Practice Address - Phone:801-716-7800
Practice Address - Fax:877-676-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
UT251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1194155010Medicaid
UT461606Medicare Oscar/Certification
UT467342Medicare Oscar/Certification