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General NPI Number Information
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NPI Number | 1689211666
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Entity Type | Organization
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Legal Business Name | GABBY CARE HOMES LLC
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 1500 PENNSYLVANIA AVE N
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City | CHAMPLIN
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State | MN
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Zip | 55316-2017
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Country | US
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Telephone | 612-481-3138
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Fax |
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Provider Business Mailing Address
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Address Line | 18594 TYLER ST NW
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City | ELK RIVER
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State | MN
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Zip | 55330-4509
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Country | US
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Telephone | 612-481-3138
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | FAITH OMURWA
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Credential |
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Telephone | 612-481-3138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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