Provider Demographics
NPI: | 1639304314 |
---|---|
Name: | IBL SOCIAL SERVICES |
Entity Type: | Organization |
Organization Name: | IBL SOCIAL SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | IONA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LEBLANC |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LBSW,IPR |
Authorized Official - Phone: | 409-892-5086 |
Mailing Address - Street 1: | 6970 LEBLANC RD |
Mailing Address - Street 2: | |
Mailing Address - City: | BEAUMONT |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77708-3311 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 409-892-5086 |
Mailing Address - Fax: | 409-892-1373 |
Practice Address - Street 1: | 6970 LEBLANC RD |
Practice Address - Street 2: | |
Practice Address - City: | BEAUMONT |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77708-3311 |
Practice Address - Country: | US |
Practice Address - Phone: | 409-892-5086 |
Practice Address - Fax: | 409-892-1337 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-05-24 |
Last Update Date: | 2009-05-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 33546 | 171M00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Single Specialty |