Organization
CORNELL INTERVENTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF REAVY (CONTRACT MGR)
(630) 824-4547
Entity
Organization
Contact information
Practice address
302 N 5TH ST, EAST SAINT LOUIS, IL 62201-2913
(618) 271-4542
Mailing address
302 N 5TH ST, EAST SAINT LOUIS, IL 62201-2913
(618) 271-4542
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
A-8981-0017-A
IL
Other
Enumeration date
05/29/2007
Last updated
08/22/2020
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