Healthcare Provider Details

I. General information

NPI: 1689211666
Provider Name (Legal Business Name): GABBY CARE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PENNSYLVANIA AVE N
CHAMPLIN MN
55316-2017
US

IV. Provider business mailing address

18594 TYLER ST NW
ELK RIVER MN
55330-4509
US

V. Phone/Fax

Practice location:
  • Phone: 612-481-3138
  • Fax:
Mailing address:
  • Phone: 612-481-3138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: FAITH OMURWA
Title or Position: ADMINISTRATOR
Credential:
Phone: 612-481-3138