Healthcare Provider Details

I. General information

NPI: 1811059694
Provider Name (Legal Business Name): GELA'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16078 TOM WHITE DR
DOLAN SPRINGS AZ
86441
US

IV. Provider business mailing address

PO BOX 1274
DOLAN SPRINGS AZ
86441-1274
US

V. Phone/Fax

Practice location:
  • Phone: 928-767-3163
  • Fax:
Mailing address:
  • Phone: 928-767-3163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELIKA HEIRD
Title or Position: MANAGER
Credential:
Phone: 928-767-3163