Provider Demographics
NPI:1336317254
Name:CORNERSTONE SERVICES INC
Entity type:Organization
Organization Name:CORNERSTONE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:STORTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-741-7042
Mailing Address - Street 1:800 BLACK RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5942
Mailing Address - Country:US
Mailing Address - Phone:815-741-7045
Mailing Address - Fax:
Practice Address - Street 1:800 BLACK RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5942
Practice Address - Country:US
Practice Address - Phone:815-741-7045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-13
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========010OtherHFS PROVIDER NUMBER