Provider Demographics
NPI:1194164442
Name:CORNELL ABRAXAS GROUP, LLC
Entity type:Organization
Organization Name:CORNELL ABRAXAS GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUSINESS MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-566-6656
Mailing Address - Street 1:2840 LIBERTY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-4776
Mailing Address - Country:US
Mailing Address - Phone:814-566-6656
Mailing Address - Fax:
Practice Address - Street 1:165 ABRAXAS RD
Practice Address - Street 2:
Practice Address - City:MARIENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16239-0059
Practice Address - Country:US
Practice Address - Phone:814-927-6615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABRAXAS ALLIANCE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-20
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA411260323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility