Provider Demographics
NPI:1386713279
Name:GIBAULT, INC.
Entity type:Organization
Organization Name:GIBAULT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW, JD
Authorized Official - Phone:812-298-3002
Mailing Address - Street 1:6301 S US HWY 41
Mailing Address - Street 2:PO BOX 2316
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-0316
Mailing Address - Country:US
Mailing Address - Phone:812-299-1156
Mailing Address - Fax:
Practice Address - Street 1:6301 S US HWY 41
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-0316
Practice Address - Country:US
Practice Address - Phone:812-299-1156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32301385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200480150AMedicaid