Organization
CORNERSTONE COMMUNITY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWNA ROHDA (OWNER)
(262) 744-1473
Entity
Organization
Contact information
Practice address
2951 N RIVER RD, WATERFORD, WI 53185-5082
(262) 744-1473
(262) 514-3485
Mailing address
2953 N RIVER RD, WATERFORD, WI 53185-5082
(262) 744-1473
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
310500000X
Mental Illness Intermediate Care Facility
—
—
311ZA0620X
Adult Care Home Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Enumeration date
08/06/2015
Last updated
09/27/2016
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