Cornerstone Management Group LLC

Key facts

NPI

1497207609

Entity type

Organization (NPI type 2)

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X

Legal business name

CORNERSTONE MANAGEMENT GROUP LLC

Practice address

302 South State Street
Gobles, MI 49055

Phone

(269) 628-2100

Fax

(269) 628-2121

NPI assigned

Nov 4, 2016

Organization subpart

No

Authorized official

Name

Tracie Hernandez

Title

Ceo

Phone

(269) 628-2100

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 4, 2016.

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478217600000",
    "number": "1497207609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 277",
            "city": "BLOOMINGDALE",
            "state": "MI",
            "postal_code": "49026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 SOUTH STATE STREET",
            "city": "GOBLES",
            "state": "MI",
            "postal_code": "49055",
            "telephone_number": "269-628-2100",
            "fax_number": "269-628-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE MANAGEMENT GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-04",
        "last_updated": "2016-11-04",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "TRACIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "269-628-2100"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Gobles, MI · Intellectual and/or Developmental Disabilities Residential Treatment Facility in Michigan