Provider Demographics
NPI:1679902936
Name:GABLES HOLDINGS LLC
Entity Type:Organization
Organization Name:GABLES HOLDINGS LLC
Other - Org Name:GABLES OF POCATELLO ASSISTED LIVING, GABLES OF BLACKFOOT ASSISTED LIVI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-785-1820
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-0026
Mailing Address - Country:US
Mailing Address - Phone:208-785-1820
Mailing Address - Fax:208-785-1824
Practice Address - Street 1:2815 HUNTERS LOOP
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-6206
Practice Address - Country:US
Practice Address - Phone:208-785-2506
Practice Address - Fax:208-785-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRC-1061310400000X
IDRC-1062310400000X
IDRC-1063310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA0001781Medicaid