Basic Information
Provider Information
NPI: 1750723086
EntityType: 2
ReplacementNPI:  
OrganizationName: EBS HEALTHCARE, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: EBS - EDUCATIONAL BASED SERVICES
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 200 SKILES BLVD
Address2:  
City: WEST CHESTER
State: PA
PostalCode: 193827321
CountryCode: US
TelephoneNumber: 8005787906
FaxNumber: 8008875852
Practice Location
Address1: 200 SKILES BLVD
Address2:  
City: WEST CHESTER
State: PA
PostalCode: 193827321
CountryCode: US
TelephoneNumber: 8005787906
FaxNumber: 8008875852
Other Information
ProviderEnumerationDate: 07/29/2013
LastUpdateDate: 07/29/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: GUMPERT
AuthorizedOfficialFirstName: JOHN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: SPECIAL EDUCATION COORDINATOR
AuthorizedOfficialTelephone: 8005787906
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
252Y00000X PAN AgenciesEarly Intervention Provider Agency 
251300000X PAY AgenciesLocal Education Agency (LEA) 

No ID Information.


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