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General NPI Number Information
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NPI Number | 1649322157
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Entity Type | Organization
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Legal Business Name | CORNELL ABRAXAS GROUP INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 437 W 6TH ST
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City | ERIE
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State | PA
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Zip | 16507-1215
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Country | US
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Telephone | 814-459-0618
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Fax | 814-459-0682
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Provider Business Mailing Address
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Address Line | 437 W 6TH ST
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City | ERIE
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State | PA
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Zip | 16507-1215
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Country | US
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Telephone | 814-459-0618
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Fax | 814-459-0682
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Authorized Official
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Title or Position | CONSULTING PSYCHIATRIST
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Name | DR. BARON DENNISTON
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Credential | M.D.
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Telephone | 814-459-0618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 405190
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License Number State | PA
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