Provider Demographics
NPI:1912327941
Name:CORNERSTONE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:CORNERSTONE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:O
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-343-1341
Mailing Address - Street 1:2445 LANE PARK RD
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-9648
Mailing Address - Country:US
Mailing Address - Phone:352-343-1341
Mailing Address - Fax:352-343-0325
Practice Address - Street 1:2445 LANE PARK RD
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-9648
Practice Address - Country:US
Practice Address - Phone:352-343-1341
Practice Address - Fax:352-343-0325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNERSTONE HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-17
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty