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General NPI Number Information
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NPI Number | 1679749139
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Entity Type | Organization
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Legal Business Name | GABRIEL CARE HOME INC
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 4617 E BEARCREEK ROAD
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City | LODI
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State | CA
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Zip | 95240
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Country | US
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Telephone | 209-369-5973
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Fax | 209-369-5698
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Provider Business Mailing Address
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Address Line | 2216 ALPINE DR
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City | LODI
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State | CA
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Zip | 95240-6703
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Country | US
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Telephone | 209-333-0592
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Fax | 209-368-2771
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Authorized Official
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Title or Position | RN ADMINISTRATOR
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Name | MRS. ELENA PAISTE GABRIEL
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Credential | RN
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Telephone | 209-598-1436
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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 | LTC80353F
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License Number State | CA
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