Organization
CORNELL ABRAXAS GROUP INC.
Active
Other names
Cornell Abraxas PSRU
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARON DENNISTON M.D, (CONSULTING PSYCHIATRIST)
(814) 459-0618
Entity
Organization
Contact information
Practice address
429 W 6TH ST, ERIE, PA 16507-1215
(814) 459-0618
(814) 459-0682
Mailing address
429 W 6TH ST, ERIE, PA 16507-1215
(814) 459-0618
(814) 459-0682
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
1007472500003
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007472500001
—
PA
Enumeration date
01/16/2007
Last updated
08/22/2020
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