CORNELL ABRAXAS GROUP, INC. (NPI# 1376518902) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376518902 |
| Entity Type | Organization |
| Organization Name | CORNELL ABRAXAS GROUP, INC. |
| Practice Address |
2775 State Route 39 Shelby OH 44875-9466 |
| Practice Telephone | 4197473322 |
| Practice Fax Number | 3816579702 |
| Mailing Telephone | 4197473322 |
| Mailing Fax Number | 4197470067 |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2012-03-14 |
| Authorized Official Name | MS. INEZ CELESTE FERRANTE (BUSINESS MANAGER) |
| Authorized Official Telephone | 4197470819 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
0680 | OH | Ambulatory Health Care Facilities |
| Y | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
FACSIS 256 | OH | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2094362 | 05 | |
| OH | 2876928 | 05 | |
| OH | 00006967 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043340052 | Cornell Abraxas Group, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 10058 S Mountain Rd, Building #3, South Mountain, PA 17261-0900 | 2007-03-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporation | Cornell Abraxas Group, Inc. | 621 NW 53rd St Ste 700 , Boca Raton, FL 33487 |
| Colorado Business Entity | CORNELL ABRAXAS GROUP, INC. | 621 NW 53rd Street, Suite 700 , Boca Raton, FL 33487 |
| Street Address |
2775 STATE ROUTE 39 |
| City | SHELBY |
| State | OH |
| Zip Code | 44875-9466 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033726039 | Paige Snyder | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-09-24 |
| 1598370751 | Erin Ball | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-09-14 |
| 1689289860 | Josh Alamanteoff | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-09-14 |
| 1891306783 | Destinee Oney | Licensed Practical Nurse | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-08-13 |
| 1548878283 | Kaitlyn Lamb | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-07-20 |
| 1083239594 | Jospeh Norris | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-06-10 |
| 1962027474 | Joseph Goracke | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-06-10 |
| 1962022814 | Jacquille Fletcher | Counselor | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-04-21 |
| 1386263036 | Mary Metoyer | Licensed Practical Nurse | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-04-13 |
| 1730718941 | Jacqueline Marie Vandriest | Licensed Practical Nurse | 2775 State Route 39, Shelby, OH 44875-9466 | 2020-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962999755 | Michael Lee Mason | Counselor | 2779 St. Rt. 39, Shelby, OH 44875 | 2018-04-17 |
| 1336646009 | Toia Branklin | Counselor | 2779 St Rt 39, Shelby, OH 44875 | 2018-04-10 |
| 1801397138 | Stephanie L Kamp | Social Worker | 29 Steele Ave, Shelby, OH 44875 | 2018-02-22 |
| 1164956744 | Brandy Brown | Licensed Practical Nurse | 2775 St. Rt. 39, Shelby, OH 44875 | 2017-04-20 |
| 1306229281 | Spencer Blevins | Specialist/Technologist | 7025 State Route 61 N, Shelby, OH 44875 | 2015-07-09 |
| 1194141150 | Karen Rittenhouse | Occupational Therapist | 109 Auburn Ave., Auburn Elementary, Shelby, OH 44875 | 2014-03-13 |
| 1467877100 | Adrianne Stumbo | Licensed Practical Nurse | 2708 Holtz Rd, Shelby, OH 44875 | 2014-03-04 |
| 1730452608 | Amy Marie Weiner | Community Health Worker | 225 West Main Street, Shelby, OH 44875 | 2012-02-22 |
| 1093038218 | Susan K Mcfarland | Licensed Practical Nurse | 77 Grand Blvd Ext, Shelby, OH 44875 | 2010-03-02 |
| 1427289362 | Mary Catherine Finnegan | Physical Therapy Assistant | 60 Grand Blvd Apt 1, Shelby, OH 44875 | 2009-07-27 |
| Find all providers in zip 44875 | ||||
| Taxonomy Code | 3245S0500X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| Specialization | Substance Abuse Treatment, Children |
| A facility or distinct part of a facility 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. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043793169 | Brandon Stone | Substance Abuse Rehabilitation Facility | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-09-13 |
| 1518457639 | Bryan K Hall | Substance Abuse Rehabilitation Facility | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-05-14 |
| 1972090892 | Curtis J Mateo | Substance Abuse Rehabilitation Facility | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-04-16 |
| 1245737444 | Matthew J Porter | Substance Abuse Rehabilitation Facility | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-04-12 |
| 1891292520 | Devon R Garrett | Substance Abuse Rehabilitation Facility | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-04-10 |
| 1780181776 | Robert Newhon | Substance Abuse Rehabilitation Facility | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-04-07 |
| 1316444300 | Jeremy Bowman | Substance Abuse Rehabilitation Facility | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-04-07 |
| 1831696970 | Gerald Polk | Substance Abuse Rehabilitation Facility | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-04-06 |
| 1932606076 | Christopher Douglass Bradford I | Substance Abuse Rehabilitation Facility | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-04-06 |
| 1568969608 | Mitchell Hall | Substance Abuse Rehabilitation Facility | 2775 State Route 39, Shelby, OH 44875-9466 | 2018-04-06 |
| Find all providers in SHELBY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.