Healthcare Provider Details

I. General information

NPI: 1902072473
Provider Name (Legal Business Name): GABRIEL CARE HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 INDIANA ST
WOODBRIDGE CA
95258-9100
US

IV. Provider business mailing address

2216 ALPINE DR
LODI CA
95240-6703
US

V. Phone/Fax

Practice location:
  • Phone: 209-333-1327
  • Fax: 209-333-1327
Mailing address:
  • Phone: 209-333-0592
  • Fax: 209-368-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License NumberLTC60986
License Number StateCA

VIII. Authorized Official

Name: MRS. ELENA PAISTE GABRIEL
Title or Position: R.N., ADMINISTRATOR
Credential: R.N.
Phone: 209-333-1327