NPIMap

Organization Active NPI

Cornell Abraxas Group Inc

Doing business as Cornell Abraxas II

  • Children's Substance Abuse Rehabilitation Facility
  • Erie, PA
National Provider Identifier
1710039227
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X
License
454310 Issued in PA
Legal business name
CORNELL ABRAXAS GROUP INC
Doing business as
Cornell Abraxas II
Practice address
502 W 6TH St
Erie, PA 16507-1129
Phone
(814) 459-0618
Fax
(814) 459-0682
NPI assigned
Jan 17, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jim Schieberl, PHD
Title
Consulting Psychologist
Phone
(814) 459-0618

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Children's Substance Abuse Rehabilitation Facility 3245S0500X 454310 PA Primary

Addresses

Primary practice location

502 W 6TH St
Erie, PA 16507-1129

Mailing address

502 W 6TH St
Erie, PA 16507-1129
Phone (814) 459-0618

Other identifiers 1

IdentifierTypeStateIssuer
1000302OtherPARESIDENTIAL TREATMENT

Other names 1

  • Cornell Abraxas II Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cornell Abraxas Midwest11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

502 W 6th St
Erie, PA 16507
Phone (814) 459-0618

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710039227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 W 6TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165071129",
            "telephone_number": "814-459-0618",
            "fax_number": "814-459-0682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 W 6TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165071129",
            "telephone_number": "814-459-0618",
            "fax_number": "814-459-0682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELL ABRAXAS GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHIEBERL",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "CONSULTING PSYCHOLOGIST",
        "authorized_official_telephone_number": "814-459-0618",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "PA",
            "license": "454310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RESIDENTIAL TREATMENT",
            "identifier": "1000302",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornell Abraxas II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.