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CORNELL ABRAXAS GROUP LLC NPI 1376518902


NPI Information

NPI: 1376518902
Provider Name: CORNELL ABRAXAS GROUP, LLC
Classification: Substance Abuse Rehabilitation Facility - 3245S0500X
Entity Type: Organization

Specialization: Substance Abuse Treatment, Children

Address:
2775 STATE ROUTE 39
SHELBY, OH
ZIP 44875
Phone: (419) 747-3322
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CORNELL ABRAXAS GROUP, LLC is a substance abuse treatment and children substance abuse rehabilitation facility in Shelby, OH. The provider is a facility or distinct part of a facility for children that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included. CORNELL ABRAXAS GROUP, LLC NPI is 1376518902. The provider is registered as an organization entity type.

The provider's business location address is:

2775 STATE ROUTE 39
SHELBY, OH
ZIP 44875-466
Phone: (419) 747-3322
Fax: (381) 657-9702

The provider's authorized official is Julia Vogt .
The authorized official title is Business Manager and has the following contact phone number (419) 747-0881.

The enumeration date for this NPI number is 2/17/2006 and was last updated on 6/13/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)0680OHIONo
23245S0500XSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, ChildrenFACSIS 256OHIOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12876928MEDICAIDOHIO
20063924MEDICAIDOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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