Provider Demographics
NPI:1649572231
Name:GALLO HOUSE I, INC.
Entity Type:Organization
Organization Name:GALLO HOUSE I, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SELG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-817-0335
Mailing Address - Street 1:9110 STAR TRAIL
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654
Mailing Address - Country:US
Mailing Address - Phone:727-868-3627
Mailing Address - Fax:727-868-3627
Practice Address - Street 1:9110 STAR TRAIL
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654
Practice Address - Country:US
Practice Address - Phone:727-868-3627
Practice Address - Fax:727-868-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL66653104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances