Basic Information
| Provider Information | |||||||||
| NPI: | 1598096034 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORNERSTONE HEALTH CARE PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVANCE NEUROLOGY AND PAIN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 WESTCHESTER DRIVE | ||||||||
| Address2: | SUITE 850 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022536 | ||||||||
| FaxNumber: | 3368022534 | ||||||||
| Practice Location | |||||||||
| Address1: | 152 EAST KINDERTON WAY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ADVANCE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270067350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369402781 | ||||||||
| FaxNumber: | 3369402782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2010 | ||||||||
| LastUpdateDate: | 05/14/2014 | ||||||||
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| AuthorizedOfficialLastName: | TERRELL | ||||||||
| AuthorizedOfficialFirstName: | GRACE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 3368022400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 5913407 | 05 | NC | MEDICAID |