Provider Demographics
NPI:1265760557
Name:PERSONAL HABILITATION SERVICES LLC
Entity type:Organization
Organization Name:PERSONAL HABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRED
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, CRC
Authorized Official - Phone:814-375-7090
Mailing Address - Street 1:150 W DUBOIS AVE
Mailing Address - Street 2:STE G
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3000
Mailing Address - Country:US
Mailing Address - Phone:814-375-7091
Mailing Address - Fax:
Practice Address - Street 1:150 W DUBOIS AVE
Practice Address - Street 2:STE G
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3000
Practice Address - Country:US
Practice Address - Phone:814-375-7091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health