Healthcare Provider Details

I. General information

NPI: 1871360032
Provider Name (Legal Business Name): GABRIEL CAREHOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 GABRIEL DR
LAS VEGAS NV
89119-6203
US

IV. Provider business mailing address

3531 KAHALA BAY LN
LAS VEGAS NV
89147-6511
US

V. Phone/Fax

Practice location:
  • Phone: 702-785-2812
  • Fax:
Mailing address:
  • Phone: 702-785-2812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TESS PASCUAL
Title or Position: PRESIDENT
Credential:
Phone: 702-785-2812