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Organization

CORNELL ABRAXAS GROUP, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JULIA VOGT (BUSINESS MANAGER)
(419) 747-0881
Entity
Organization

Contact information

Practice address
2775 STATE ROUTE 39, SHELBY, OH 44875-9466
(419) 747-3322
(381) 657-9702
Mailing address
2775 STATE ROUTE 39, SHELBY, OH 44875-9466
(419) 747-3322
(419) 747-0067

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
0680
OH
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
FACSIS 256
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0063924
OH
05
2876928
OH
Enumeration date
02/17/2006
Last updated
06/13/2022
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