Provider Demographics
NPI:1891380986
Name:GREEN GABLES CARE HOME
Entity Type:Organization
Organization Name:GREEN GABLES CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEAKALEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-307-0950
Mailing Address - Street 1:PO BOX 2481
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91386-2481
Mailing Address - Country:US
Mailing Address - Phone:559-307-0950
Mailing Address - Fax:661-209-3076
Practice Address - Street 1:1549 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-3124
Practice Address - Country:US
Practice Address - Phone:559-297-4152
Practice Address - Fax:661-209-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty