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Gabriel Icf
Intellectual Disabilities Intermediate Care Facility in Lodi, California
NPI 1104976794

Gabriel Icf is a Intellectual Disabilities Intermediate Care Facility based in Lodi, CA. Gabriel Icf practices in Lodi, CA. The NPI Number for Gabriel Icf is 1104976794 and holds a License No. LTC80160F (California).

The current practice location address for Gabriel Icf is 2155 W Elm Street, Lodi, CA and can be reached out via phone at 209-333-0592 and via fax at 209-368-2771.

Location: 2155 W Elm Street, Lodi, CA, 95240-6703
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1104976794
Provider Name
Gabriel Icf
Credential
Provider Entity Type
Organization
Address
2155 W Elm Street, Lodi, CA, 95240-6703
Phone Number
209-333-0592
Fax Number
209-368-2771
Provider Enumeration Date
01/12/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
LTC80160F 05 CA
institution
Provider Business Practice Location Address Details
Address
2155 W Elm Street
City
Lodi
State
California
Zip
95242-6703
Phone Number
209-333-0592
Fax Number
209-368-2771
person
Provider Business Mailing Address Details
Address
2155 W Elm Street
City
Lodi
State
California
Zip
95242-6703
Phone Number
209-333-0592
Fax Number
209-368-2771
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
LTC80160F (California)
Definition
(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
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