Provider Demographics
NPI:1134389943
Name:GABRIELLE'S HOUSE
Entity type:Organization
Organization Name:GABRIELLE'S HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:MSE
Authorized Official - Phone:804-763-1474
Mailing Address - Street 1:10524 BRIGHTSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1570
Mailing Address - Country:US
Mailing Address - Phone:804-763-1474
Mailing Address - Fax:
Practice Address - Street 1:725 S PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-3337
Practice Address - Country:US
Practice Address - Phone:804-763-1474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-15
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VASS-395/5431-08322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children