Provider Demographics
NPI:1801140207
Name:BIBBUS, WILLIAM GENE
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GENE
Last Name:BIBBUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:MEADVIEW
Mailing Address - State:AZ
Mailing Address - Zip Code:86444-0729
Mailing Address - Country:US
Mailing Address - Phone:484-824-3068
Mailing Address - Fax:
Practice Address - Street 1:1515 WISHING WELL DR
Practice Address - Street 2:
Practice Address - City:MEADVIEW
Practice Address - State:AZ
Practice Address - Zip Code:86444-0729
Practice Address - Country:US
Practice Address - Phone:484-824-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
AZ1747326385HR2055X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child