Healthcare Provider Details

I. General information

NPI: 1871749119
Provider Name (Legal Business Name): GIBAULT , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 S US HIGHWAY 41
TERRE HAUTE IN
47802-4771
US

IV. Provider business mailing address

6301 S US HIGHWAY 41 PO BOX 2316
TERRE HAUTE IN
47802-4771
US

V. Phone/Fax

Practice location:
  • Phone: 812-299-1156
  • Fax: 812-298-3044
Mailing address:
  • Phone: 812-299-1156
  • Fax: 812-298-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number32301
License Number StateIN

VIII. Authorized Official

Name: JAMES M SINCLAIR
Title or Position: PRESIDENT/CEO
Credential: MSSW, JD
Phone: 812-298-3002