Provider Demographics
NPI:1699062182
Name:CORNERSTONE FOUNDATION
Entity type:Organization
Organization Name:CORNERSTONE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-935-1649
Mailing Address - Street 1:105 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1423
Mailing Address - Country:US
Mailing Address - Phone:608-935-1649
Mailing Address - Fax:608-935-0804
Practice Address - Street 1:105 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1423
Practice Address - Country:US
Practice Address - Phone:608-935-1649
Practice Address - Fax:608-935-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities