Provider Demographics
NPI:1649741182
Name:PB OUTPATIENT SERVICES PENNSYLVANIA, LLC
Entity Type:Organization
Organization Name:PB OUTPATIENT SERVICES PENNSYLVANIA, LLC
Other - Org Name:THE RANCH PENNSYLVANIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SASSERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-994-3972
Mailing Address - Street 1:PO BOX 207822
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7822
Mailing Address - Country:US
Mailing Address - Phone:847-329-4100
Mailing Address - Fax:
Practice Address - Street 1:1166 HILTS RD
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17368-9205
Practice Address - Country:US
Practice Address - Phone:562-303-9506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility