MEDICARE: GELA'S HOME

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	311ZA0620X	Adult Care Home Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811059694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GELA'S HOME

Provider Business Mailing Address
First Line	:	PO BOX 1274
Second Line	:
City	:	DOLAN SPRINGS
State	:	AZ
Zip	:	86441-1274
Country	:	US
Telephone Number	:	928-767-3163
Fax Number	:

Provider Business Practice Location Address
First Line	:	16078 TOM WHITE DR
Second Line	:
City	:	DOLAN SPRINGS
State	:	AZ
Zip	:	86441
Country	:	US
Telephone Number	:	928-767-3163
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. ANGELIKA HEIRD
Credential	:
Telephone Number	:	928-767-3163

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/10/2008

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Directions to “GELA'S HOME ” Practice Location

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