Provider Demographics
NPI:1801542915
Name:CORNERSTONE INTEGRATED HEALTHCARE OF OHIO LLC
Entity type:Organization
Organization Name:CORNERSTONE INTEGRATED HEALTHCARE OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:UZOH-ANIGBOGU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, FNP- BC, RN
Authorized Official - Phone:614-668-2671
Mailing Address - Street 1:6495 E BROAD ST STE J
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1541
Mailing Address - Country:US
Mailing Address - Phone:614-668-2671
Mailing Address - Fax:614-694-0959
Practice Address - Street 1:6495 E BROAD ST STE J
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1541
Practice Address - Country:US
Practice Address - Phone:614-668-2671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty