Provider Demographics
NPI:1457003584
Name:PBS CORPORATION
Entity Type:Organization
Organization Name:PBS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-832-6727
Mailing Address - Street 1:1142 RANKIN OAKS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5797
Mailing Address - Country:US
Mailing Address - Phone:678-699-0917
Mailing Address - Fax:
Practice Address - Street 1:10605 DANESWAY LN
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-9310
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty