Provider Demographics
NPI:1821796681
Name:GIBAULT, INC.
Entity Type:Organization
Organization Name:GIBAULT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ATCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-298-3201
Mailing Address - Street 1:6401 S US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4749
Mailing Address - Country:US
Mailing Address - Phone:812-298-3201
Mailing Address - Fax:812-298-3044
Practice Address - Street 1:7403 CLINE AVE
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2645
Practice Address - Country:US
Practice Address - Phone:812-298-3201
Practice Address - Fax:812-298-3044
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GIBAULT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility