Provider Demographics
NPI:1396509766
Name:GATEWAY RESIDENTIAL SERVICES, LLC
Entity type:Organization
Organization Name:GATEWAY RESIDENTIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARTHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-515-8798
Mailing Address - Street 1:9660 COMMERCE DR STE 305
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7640
Mailing Address - Country:US
Mailing Address - Phone:317-350-8811
Mailing Address - Fax:317-350-8611
Practice Address - Street 1:9660 COMMERCE DR STE 305
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7640
Practice Address - Country:US
Practice Address - Phone:317-350-8811
Practice Address - Fax:317-350-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services