Provider Demographics
NPI:1124636386
Name:GATEWAY HOSPICE PROVIDERS LLC
Entity type:Organization
Organization Name:GATEWAY HOSPICE PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-499-6669
Mailing Address - Street 1:821 SW ALSBURY BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:821 SW ALSBURY BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4090
Practice Address - Country:US
Practice Address - Phone:682-499-6669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based