Provider Demographics
NPI:1346298064
Name:THE GILBERT RESIDENCE, INC.
Entity Type:Organization
Organization Name:THE GILBERT RESIDENCE, INC.
Other - Org Name:THE GILBERT RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-482-9498
Mailing Address - Street 1:203 S HURON ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5422
Mailing Address - Country:US
Mailing Address - Phone:734-482-9498
Mailing Address - Fax:734-482-1848
Practice Address - Street 1:203 S HURON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5422
Practice Address - Country:US
Practice Address - Phone:734-482-9498
Practice Address - Fax:734-482-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI81-4030313M00000X
MI310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2082758Medicaid