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General NPI Number Information
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NPI Number | 1790828978
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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 | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 437 TURRETT ST
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City | PITTSBURGH
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State | PA
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Zip | 15206-3370
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Country | US
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Telephone | 412-361-0904
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Fax |
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Provider Business Mailing Address
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Address Line | 437 TURRETT ST
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City | PITTSBURGH
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State | PA
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Zip | 15206-3370
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Country | US
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Telephone | 412-361-0904
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Fax |
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Authorized Official
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Title or Position | SR BUSINESS MANAGER
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Name | JOHN SADLER
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Credential |
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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 | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 458290
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License Number State | PA
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