Provider Demographics
NPI:1285111906
Name:CORNERSTONE SENIOR CARE AND ASSISTED LIVING,LLC
Entity type:Organization
Organization Name:CORNERSTONE SENIOR CARE AND ASSISTED LIVING,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOSHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-951-1933
Mailing Address - Street 1:1233 MUSCOGEE TRL
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-1165
Mailing Address - Country:US
Mailing Address - Phone:972-248-7848
Mailing Address - Fax:
Practice Address - Street 1:3900 JOE RAMSEY BLVD E BLDG 10A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7727
Practice Address - Country:US
Practice Address - Phone:972-951-1933
Practice Address - Fax:972-395-1272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health