Provider Demographics
NPI:1790828978
Name:CORNELL ABRAXAS GROUP INC
Entity Type:Organization
Organization Name:CORNELL ABRAXAS GROUP INC
Other - Org Name:ABRAXAS III
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-459-0618
Mailing Address - Street 1:437 TURRETT ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3370
Mailing Address - Country:US
Mailing Address - Phone:412-361-0904
Mailing Address - Fax:
Practice Address - Street 1:437 TURRETT ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3370
Practice Address - Country:US
Practice Address - Phone:412-361-0904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4582903245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA458290OtherDDAPL LICENSE