Provider Demographics
NPI:1013183581
Name:GABRIEL CARE HOME INC
Entity Type:Organization
Organization Name:GABRIEL CARE HOME INC
Other - Org Name:ALPINE ICF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R.N.,ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:PAISTE
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:209-598-1436
Mailing Address - Street 1:2216 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-6703
Mailing Address - Country:US
Mailing Address - Phone:209-333-0592
Mailing Address - Fax:209-368-2771
Practice Address - Street 1:2216 ALPINE DR
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6703
Practice Address - Country:US
Practice Address - Phone:209-333-0592
Practice Address - Fax:209-368-2771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GABRIEL CARE HOME INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALTC80271F315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities