Provider Demographics
NPI:1316061880
Name:CORNERSTONE HEALTH CARE PA
Entity type:Organization
Organization Name:CORNERSTONE HEALTH CARE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-802-2400
Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2536
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:1814 WESTCHESTER DRIVE
Practice Address - Street 2:SUITE 301
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7369
Practice Address - Country:US
Practice Address - Phone:336-802-2588
Practice Address - Fax:336-802-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCB8658OtherRR MEDICARE
NCCC4241OtherRR MEDICARE
NCCC4243OtherRR MEDICARE
NCCD6614OtherRR MEDICARE
NCCD6614OtherRR MEDICARE