Provider Demographics
NPI:1548843329
Name:GABBY CARE HOMES LLC - OREGON HOUSE
Entity type:Organization
Organization Name:GABBY CARE HOMES LLC - OREGON HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBWAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-649-1097
Mailing Address - Street 1:18594 TYLER ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-4509
Mailing Address - Country:US
Mailing Address - Phone:612-481-3138
Mailing Address - Fax:763-298-4582
Practice Address - Street 1:11917 OREGON AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2222
Practice Address - Country:US
Practice Address - Phone:952-649-1097
Practice Address - Fax:763-298-4582
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GABBY CARE HOMES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility