Provider Demographics
NPI:1477603678
Name:SAINT GABRIEL'S SYSTEM
Entity type:Organization
Organization Name:SAINT GABRIEL'S SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVORITANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-665-8777
Mailing Address - Street 1:1350 PAWLINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19407-7280
Mailing Address - Country:US
Mailing Address - Phone:215-247-2776
Mailing Address - Fax:610-666-1698
Practice Address - Street 1:1350 PAWLINGS ROAD
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19407-7280
Practice Address - Country:US
Practice Address - Phone:215-247-2776
Practice Address - Fax:610-666-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA139210323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007722800001Medicaid
PA1007722800022Medicaid
PA1007722800009Medicaid
PA1007722800004Medicaid
PA1007722800007Medicaid