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General NPI Number Information
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NPI Number | 1598810764
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Entity Type | Organization
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Legal Business Name | CORNELL INTERVENTIONS, LLC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 5701 S WOOD ST
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City | CHICAGO
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State | IL
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Zip | 60636-1646
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Country | US
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Telephone | 773-737-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 2840 LIBERTY AVE STE 300
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City | PITTSBURGH
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State | PA
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Zip | 15222-4776
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Country | US
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Telephone | 412-201-4112
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Fax |
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Authorized Official
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Title or Position | CONTRACTS DIRECTOR
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Name | SHAYNA A RAVER
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Credential |
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Telephone | 724-622-4502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | A-8981-0019-A
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License Number State | IL
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