Provider Demographics
NPI:1548317092
Name:CORNERSTONE ADULT SERVICES, INC.
Entity type:Organization
Organization Name:CORNERSTONE ADULT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MERKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-739-2844
Mailing Address - Street 1:140 WARWICK NECK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-5308
Mailing Address - Country:US
Mailing Address - Phone:401-739-2844
Mailing Address - Fax:401-739-5388
Practice Address - Street 1:140 WARWICK NECK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-5308
Practice Address - Country:US
Practice Address - Phone:401-739-2844
Practice Address - Fax:401-739-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI408;409;410;411;412251C00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIV650P-3665OtherVA CONTRACT AWARD NUMBER
RI31OtherRESPITE CARE VENDOR NO.
RICA03373Medicaid