Provider Demographics
NPI:1083164453
Name:TABOR CHILDREN'S SERVICES
Entity Type:Organization
Organization Name:TABOR CHILDREN'S SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HAUSSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-842-4800
Mailing Address - Street 1:57 E ARMAT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2201
Mailing Address - Country:US
Mailing Address - Phone:215-842-4800
Mailing Address - Fax:215-842-4809
Practice Address - Street 1:57 E ARMAT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2201
Practice Address - Country:US
Practice Address - Phone:215-842-4800
Practice Address - Fax:215-842-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health