Provider Demographics
NPI:1487846820
Name:THE GABRIEL HOUSE
Entity type:Organization
Organization Name:THE GABRIEL HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUCE
Authorized Official - Suffix:
Authorized Official - Credentials:01291950
Authorized Official - Phone:936-433-5974
Mailing Address - Street 1:4530 U S HIGHWAY 190 E
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-1473
Mailing Address - Country:US
Mailing Address - Phone:936-327-7075
Mailing Address - Fax:936-327-5143
Practice Address - Street 1:4530 U S HIGHWAY 190 E
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-1473
Practice Address - Country:US
Practice Address - Phone:936-327-7075
Practice Address - Fax:936-327-5143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000999904315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities