Provider Demographics
NPI:1619334646
Name:CORNELL INTERVENTIONS, INC.
Entity Type:Organization
Organization Name:CORNELL INTERVENTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISIONAL VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWATSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-201-4111
Mailing Address - Street 1:2221 64TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2180
Mailing Address - Country:US
Mailing Address - Phone:630-968-6477
Mailing Address - Fax:
Practice Address - Street 1:2221 64TH ST
Practice Address - Street 2:2ND FLOOR - MEN'S UNIT
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2180
Practice Address - Country:US
Practice Address - Phone:630-968-6477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-8981-0010-A261QR0405X
ILA89810010A324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder