Provider Demographics
NPI:1316069289
Name:PERSON DIRECTED SUPPORTS, INC.
Entity type:Organization
Organization Name:PERSON DIRECTED SUPPORTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIBAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-350-1029
Mailing Address - Street 1:1541 ALTA DR STE 202
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-5643
Mailing Address - Country:US
Mailing Address - Phone:484-350-1029
Mailing Address - Fax:
Practice Address - Street 1:1234 ELLSWORTH DR
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-4604
Practice Address - Country:US
Practice Address - Phone:484-350-1029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007042L103TB0200X
163W00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100003346OtherDPW PROMISE MPI#