Provider Demographics
NPI:1215462296
Name:GATEWAY HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:GATEWAY HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-585-0531
Mailing Address - Street 1:3022 JAVIER RD
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4645
Mailing Address - Country:US
Mailing Address - Phone:703-462-8725
Mailing Address - Fax:
Practice Address - Street 1:3022 JAVIER RD
Practice Address - Street 2:SUITE # 207
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4645
Practice Address - Country:US
Practice Address - Phone:703-462-8725
Practice Address - Fax:703-462-8726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-171543251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health