Provider Demographics
NPI:1811224645
Name:GIBSON CO. AREA REHABILITATION CENTERS, INC
Entity Type:Organization
Organization Name:GIBSON CO. AREA REHABILITATION CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CHILDREN'S SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-385-4968
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:4207 W. STATE ROAD 64
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-0005
Mailing Address - Country:US
Mailing Address - Phone:812-386-6312
Mailing Address - Fax:812-385-8778
Practice Address - Street 1:421 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-2443
Practice Address - Country:US
Practice Address - Phone:812-385-4968
Practice Address - Fax:812-386-5208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251C00000X251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN251C00000XOtherDEVELOPMENTAL DISABILITIES AGENCY