Organization
CORNERSTONE SUPPPORT CILA HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA MOORE (CEO)
(773) 996-4545
Entity
Organization
Contact information
Practice address
125 E 144TH CT, HARVEY, IL 60426-1218
(773) 996-4545
Mailing address
125 E 144TH CT, HARVEY, IL 60426-1218
(773) 996-4545
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/11/2016
Last updated
10/11/2016
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