Healthcare Provider Details

I. General information

NPI: 1861283517
Provider Name (Legal Business Name): GABRIEL COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11402 COVERED BRIDGE CT
GLENN DALE MD
20769-9130
US

IV. Provider business mailing address

11402 COVERED BRIDGE CT
GLENN DALE MD
20769-9130
US

V. Phone/Fax

Practice location:
  • Phone: 301-814-0037
  • Fax: 877-408-0066
Mailing address:
  • Phone: 240-584-8869
  • Fax: 301-814-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LUCY IMMI K
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-584-8869