Provider Demographics
NPI:1871594705
Name:CORNERSTONE HOSPICE INC.
Entity type:Organization
Organization Name:CORNERSTONE HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:909-872-8100
Mailing Address - Street 1:1461 E COOLEY DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3921
Mailing Address - Country:US
Mailing Address - Phone:909-872-8100
Mailing Address - Fax:909-872-8106
Practice Address - Street 1:1461 E COOLEY DR
Practice Address - Street 2:SUITE 220
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3921
Practice Address - Country:US
Practice Address - Phone:909-872-8100
Practice Address - Fax:909-872-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01767FMedicaid
CA051767Medicare Oscar/Certification