Provider Demographics
NPI:1518507110
Name:GEMS RESIDENCE LLC
Entity Type:Organization
Organization Name:GEMS RESIDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARAM
Authorized Official - Middle Name:CHANNEH
Authorized Official - Last Name:CEESAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:425-463-8789
Mailing Address - Street 1:5810 LIVERPOOL ST
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1909
Mailing Address - Country:US
Mailing Address - Phone:425-463-8789
Mailing Address - Fax:
Practice Address - Street 1:5810 LIVERPOOL ST
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-1909
Practice Address - Country:US
Practice Address - Phone:425-463-8789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities