Provider Demographics
NPI:1619290343
Name:PAC FAMILY BASED SERVICES
Entity Type:Organization
Organization Name:PAC FAMILY BASED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, MBA
Authorized Official - Phone:724-458-9330
Mailing Address - Street 1:P.O. BOX 1333
Mailing Address - Street 2:3900 SKIPPACK PIKE, SUITE C-2
Mailing Address - City:SKIPPACK
Mailing Address - State:PA
Mailing Address - Zip Code:19474
Mailing Address - Country:US
Mailing Address - Phone:267-257-6804
Mailing Address - Fax:
Practice Address - Street 1:1250 GERMANTOWN PIKE STE 200
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2444
Practice Address - Country:US
Practice Address - Phone:267-644-8448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREVENTATIVE AFTERCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-09
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024789290002Medicaid