Organization
CORNERSTONE SUPPORTED LIVING
Active
Other names
Cornerstone Transport
Organization subpart
No
Provider details
NPI number
Authorized official
JAMILA GILLIAM (ADMINISTRATOR)
(907) 302-8366
Entity
Organization
Contact information
Practice address
3400 E RIVER VALLEY ST APT J202, MERIDIAN, ID 83646-2361
(907) 302-8366
(208) 955-5608
Mailing address
3400 E RIVER VALLEY ST APT J202, MERIDIAN, ID 83646-2361
(907) 302-8366
(208) 955-5608
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
251E00000X
Home Health Agency
—
—
251X00000X
Supports Brokerage Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
310400000X
Assisted Living Facility
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
12/26/2019
Last updated
12/26/2019
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