Provider Demographics
NPI:1710012810
Name:CORNERSTONE HOME HEALTH CARE, INC
Entity type:Organization
Organization Name:CORNERSTONE HOME HEALTH CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-430-2258
Mailing Address - Street 1:576 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1342
Mailing Address - Country:US
Mailing Address - Phone:317-834-8034
Mailing Address - Fax:317-584-3016
Practice Address - Street 1:576 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1342
Practice Address - Country:US
Practice Address - Phone:317-834-8034
Practice Address - Fax:317-584-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11-012076-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN104159157799Medicaid
IN679231OtherBLUE CROSS BLUE SHIELD OF INDIANA
IN104159157799Medicaid