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NPI Code Detail

MEDICARE: CORNELL ABRAXAS GROUP, LLC

MEDICARE: CORNELL ABRAXAS GROUP, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320800000XMental Illness Community Based Residential Treatment Facility0680OH
23245S0500XChildren's Substance Abuse Rehabilitation Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134385669
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORNELL ABRAXAS GROUP, LLC
Provider Business Mailing Address
First Line : 2775 STATE ROUTE 39
Second Line :
City : SHELBY
State : OH
Zip : 44875-9466
Country : US
Telephone Number : 419-347-3322
Fax Number : 419-747-0067
Provider Business Practice Location Address
First Line : 2775 STATE ROUTE 39
Second Line :
City : SHELBY
State : OH
Zip : 44875-9466
Country : US
Telephone Number : 419-347-3322
Fax Number : 419-747-0067
Authorized Official
Title or Position : BUSINESS MANAGER
Name : JULIA VOGT
Credential :
Telephone Number : 419-747-0881
Provider Enumeration Date : 08/04/2008
Last Update Date : 06/13/2022

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Directions to “CORNELL ABRAXAS GROUP, LLC ” Practice Location

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