Provider Demographics
NPI:1255673927
Name:TABOR CHILDREN'S SERVICES
Entity Type:Organization
Organization Name:TABOR CHILDREN'S SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
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 1:601 NEW BRITAIN RD
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2788
Mailing Address - Country:US
Mailing Address - Phone:215-842-4800
Mailing Address - Fax:215-348-9261
Practice Address - Street 1:6667 MUSGRAVE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2266
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:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA100003856320800000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100003856OtherPROMISE