Provider Demographics
NPI:1538356936
Name:CORNERSTONE VILLAGE SOUTH, INC
Entity type:Organization
Organization Name:CORNERSTONE VILLAGE SOUTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LINSCOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-981-5335
Mailing Address - Street 1:103 W MARTIAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6719
Mailing Address - Country:US
Mailing Address - Phone:337-981-5335
Mailing Address - Fax:
Practice Address - Street 1:103 W MARTIAL AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6719
Practice Address - Country:US
Practice Address - Phone:337-981-5335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA482314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility