GIBSON CENTER FOR BEHAVIORAL CHANGE NPI 1184774275

NPI Information

GIBSON CENTER FOR BEHAVIORAL CHANGE is a substance abuse rehabilitation facility in Cape Girardeau, MO. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. GIBSON CENTER FOR BEHAVIORAL CHANGE NPI is 1184774275. The provider is registered as an organization entity type.

The provider's business location address is:

1112 LINDEN ST
CAPE GIRARDEAU, MO
ZIP 63703-707
Phone: (573) 332-0416
Fax: (573) 334-0312

The provider's authorized official is Ryan Essex .
The authorized official title is Chief Operating Officer and has the following contact phone number (573) 803-4145.

The CLIA number assigned to this NPI record is 26D1080201 - comp. outpatient rehab facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/11/2007 and was last updated on 1/31/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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