Healthcare Provider Details

I. General information

NPI: 1598810764
Provider Name (Legal Business Name): CORNELL INTERVENTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 S WOOD ST
CHICAGO IL
60636-1646
US

IV. Provider business mailing address

2840 LIBERTY AVE STE 300
PITTSBURGH PA
15222-4776
US

V. Phone/Fax

Practice location:
  • Phone: 773-737-4600
  • Fax:
Mailing address:
  • Phone: 412-201-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberA-8981-0019-A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SHAYNA A RAVER
Title or Position: CONTRACTS DIRECTOR
Credential:
Phone: 724-622-4502