Basic Information
| Provider Information | |||||||||
| NPI: | 1245280916 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORNERSTONE REHABILITATION AND HEALTHCARE CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 302 ALCORN DR | ||||||||
| Address2: | |||||||||
| City: | CORINTH | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388346979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622862286 | ||||||||
| FaxNumber: | 6622862289 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 ALCORN DR | ||||||||
| Address2: | |||||||||
| City: | CORINTH | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388346979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622862286 | ||||||||
| FaxNumber: | 6622862289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 10/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | MEER | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT & SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 6296260000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ARK MISSISSIPPI HOLDING COMPANY, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 500 | MS | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 230068 | 05 | MS | MEDICAID |