Provider Demographics
NPI:1073090429
Name:GABBY CARE HOMES LLC
Entity Type:Organization
Organization Name:GABBY CARE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:OMURWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-481-3138
Mailing Address - Street 1:18594 TYLER ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-4509
Mailing Address - Country:US
Mailing Address - Phone:612-481-3138
Mailing Address - Fax:
Practice Address - Street 1:1512 PENNSYLVANIA AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2017
Practice Address - Country:US
Practice Address - Phone:612-481-3138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN386618310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility