NPIMap

Organization Active NPI

Cornell Abraxas Group LLC

  • Children's Substance Abuse Rehabilitation Facility
  • Marienville, PA
National Provider Identifier
1972645893
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X
License
271010 Issued in PA
Legal business name
CORNELL ABRAXAS GROUP LLC
Practice address
165 Abraxas Road
Marienville, PA 16239
Phone
(814) 566-6656
Fax
(814) 927-8560
NPI assigned
Feb 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

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

Authorized official

Name
John Sadler
Title
Director of Business Operations
Phone
(814) 566-6656

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Children's Substance Abuse Rehabilitation Facility 3245S0500X 271010 PA Primary

Addresses

Primary practice location

165 Abraxas Road
Marienville, PA 16239

Mailing address

2840 Liberty Ave Ste 300
Pittsburgh, PA 15222-4776
Phone (814) 566-6656

Other identifiers 1

IdentifierTypeStateIssuer
271010OtherPADDAPL LICENSE

Other names 1

  • Cornell Abraxas I Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0900325Abraxas I165 Abraxas Road, Marienville, PA 16239Certificate of waiverApr 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cornell Abraxas Group LLC11 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.

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699833600000",
    "number": "1972645893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2840 LIBERTY AVE STE 300",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152224776",
            "telephone_number": "814-566-6656",
            "fax_number": "814-927-8560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 ABRAXAS ROAD",
            "city": "MARIENVILLE",
            "state": "PA",
            "postal_code": "16239",
            "telephone_number": "814-566-6656",
            "fax_number": "814-927-8560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELL ABRAXAS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2023-11-13",
        "certification_date": "2023-10-26",
        "status": "A",
        "authorized_official_last_name": "SADLER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS OPERATIONS",
        "authorized_official_telephone_number": "814-566-6656"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "PA",
            "license": "271010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DDAPL LICENSE",
            "identifier": "271010",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornell Abraxas I",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cornell Abraxas I",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marienville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.