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General NPI Number Information
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NPI Number | 1487846820
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Entity Type | Organization
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Legal Business Name | THE GABRIEL HOUSE
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 4530 U S HIGHWAY 190 E
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City | LIVINGSTON
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State | TX
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Zip | 77351-1473
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Country | US
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Telephone | 936-327-7075
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Fax | 936-327-5143
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Provider Business Mailing Address
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Address Line | 4530 U S HIGHWAY 190 E
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City | LIVINGSTON
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State | TX
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Zip | 77351-1473
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Country | US
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Telephone | 936-327-7075
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Fax | 936-327-5143
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. EDNA M LUCE
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Credential | 01291950
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Telephone | 936-433-5974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 000999904
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License Number State | TX
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