Provider Demographics
NPI:1730201054
Name:CORNERSTONE CARE, INC.
Entity type:Organization
Organization Name:CORNERSTONE CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KLOUDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-334-0411
Mailing Address - Street 1:645 MCHENRY AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-2922
Mailing Address - Country:US
Mailing Address - Phone:815-334-0411
Mailing Address - Fax:815-334-0413
Practice Address - Street 1:645 MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-2922
Practice Address - Country:US
Practice Address - Phone:815-334-0411
Practice Address - Fax:815-334-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty