Provider Demographics
NPI:1508999194
Name:GIBBS CARE HOME, INC.
Entity Type:Organization
Organization Name:GIBBS CARE HOME, INC.
Other - Org Name:GIBBS CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:ARNETTA
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:832-668-5323
Mailing Address - Street 1:PO BOX 451485
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77245-1485
Mailing Address - Country:US
Mailing Address - Phone:832-668-5323
Mailing Address - Fax:832-539-1299
Practice Address - Street 1:5331 W OREM DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-5036
Practice Address - Country:US
Practice Address - Phone:832-668-5323
Practice Address - Fax:832-539-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52231104100000X
251S00000X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0653719-02Medicaid
TX001012341Medicaid
TX0810848-01Medicaid
TX1016020OtherDEPT OF AGING& DISABILITY
TX17086584Medicaid
TX1016020OtherDEPT OF AGING& DISABILITY