Provider Demographics
NPI:1053746388
Name:CORNERSTONE SERVICES, INC
Entity type:Organization
Organization Name:CORNERSTONE SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STORTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-741-7045
Mailing Address - Street 1:1475 HARVARD DR # 3
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-8451
Mailing Address - Country:US
Mailing Address - Phone:815-823-8412
Mailing Address - Fax:815-823-8431
Practice Address - Street 1:1475 HARVARD DR # 3
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-8451
Practice Address - Country:US
Practice Address - Phone:815-823-8412
Practice Address - Fax:815-823-8431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04039OtherDEPT OF HUMAN SERVICES CERTIFICATION NUMBER