Provider Demographics
NPI:1639202906
Name:GWENDOLYN A. GIBBS
Entity Type:Organization
Organization Name:GWENDOLYN A. GIBBS
Other - Org Name:DAYBREAK REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:ARNETTA
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-818-4443
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:713-433-0528
Mailing Address - Fax:713-433-1462
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:713-433-0528
Practice Address - Fax:713-433-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454730Medicare Oscar/Certification
TX454730Medicare ID - Type UnspecifiedCOMMUNITY MENTAL HEALTH