Organization
PERSON DIRECTED SUPPORTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH L GIBAT (CHIEF OPERATING OFFICER)
(484) 350-1029
Entity
Organization
Contact information
Practice address
1234 ELLSWORTH DR, WHITEHALL, PA 18052-4604
(484) 350-1029
Mailing address
1541 ALTA DR STE 202, WHITEHALL, PA 18052-5643
(484) 350-1029
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
PS007042L
PA
163W00000X
Registered Nurse
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100003346
DPW PROMISE MPI#
PA
Enumeration date
04/04/2007
Last updated
11/21/2017
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