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General NPI Number Information
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NPI Number | 1568517308
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Entity Type | Organization
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Legal Business Name | CORNELL COMPANIES
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 26991 N ANDERSON RD
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City | WAUCONDA
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State | IL
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Zip | 60084-2352
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Country | US
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Telephone | 847-526-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 26991 N ANDERSON RD
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City | WAUCONDA
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State | IL
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Zip | 60084-2352
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Country | US
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Telephone | 847-526-0404
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Fax |
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Authorized Official
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Title or Position | SR BUSINESS MGR
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Name | JEFF REAVY
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Credential |
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Telephone | 630-824-4547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | A-8981-0001-A
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License Number State | IL
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