DEBOORAH A GIBSON
Adult Care Home
Lindstrom, Minnesota
Provider NPI: 1780844613
Provider Information:DEBOORAH A GIBSON
Practice Location:
28131 NEWBERRY TRAIL LINDSTROM, MN 55045 US
Tel: 651-657-3684 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 311ZA0620X | Nursing & Custodial Care Facilities Custodial Care Facility Adult Care Home | MN | 1020292-1-AFC |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
MEDICA | 49-80610 | MN | 01 |
UCARE | 161648 | MN | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin