MEDICARE: GIBSON COUNTY AREA REHABILITATION CENTERS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		IN

General Provider Information

NPI Number	:	1861606725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIBSON COUNTY AREA REHABILITATION CENTERS INC

Provider Business Mailing Address
First Line	:	PO BOX 5
Second Line	:
City	:	PRINCETON
State	:	IN
Zip	:	47670-0005
Country	:	US
Telephone Number	:	812-386-6312
Fax Number	:	812-385-8778

Provider Business Practice Location Address
First Line	:	1015 S STOUT ST
Second Line	:
City	:	PRINCETON
State	:	IN
Zip	:	47670-2742
Country	:	US
Telephone Number	:	812-386-1042
Fax Number	:	812-386-7325

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DANIEL J COCKRUM
Credential	:
Telephone Number	:	812-386-6312

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/22/2020

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