| Cornerstone Whole Healthcare Organization, Inc. | |
|
824 S Diamond St Nampa ID 83686-5960 | |
| (208) 606-0396 | |
| Not Available |
| Full Name | Cornerstone Whole Healthcare Organization, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 824 S Diamond St, Nampa, Idaho |
| Authorized Official Name and Position | Jennifer Yturriondobeitia (CEO) |
| Authorized Official Contact | 2088999012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cornerstone Whole Healthcare Organization, Inc. 11485 Payette Heights Rd Payette ID 83661-5012 Ph: (208) 899-9012 | Cornerstone Whole Healthcare Organization, Inc. 824 S Diamond St Nampa ID 83686-5960 Ph: (208) 606-0396 |
| NPI Number | 1164153508 |
|---|---|
| Provider Enumeration Date | 06/17/2022 |
| Last Update Date | 03/13/2023 |
| Medicare PECOS PAC ID | 9830564665 |
|---|---|
| Medicare Enrollment ID | O20230410002158 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164153508 | NPI | - | NPPES |
| 020256 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Kaitlin Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457828451 PECOS PAC ID: 0143617373 Enrollment ID: I20220418002254 |
| Provider Name | Leo Alfred Carney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811972706 PECOS PAC ID: 4183628597 Enrollment ID: I20230707000638 |
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