Organization
GABRIEL ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GOMGOM SIREGAR (OWNER)
(720) 998-6372
Entity
Organization
Contact information
Practice address
5235 S LIVERPOOL WAY, CENTENNIAL, CO 80015-6425
(303) 954-0531
Mailing address
5235 S LIVERPOOL WAY, CENTENNIAL, CO 80015-6425
(303) 954-0531
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
23L573
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87637065
MEDICAID PROVIDER NUMBER
CO
Enumeration date
08/16/2016
Last updated
08/16/2016
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