Provider Demographics
NPI:1023014271
Name:GATEWAY HEALTH CARE CENTRES LIMITED PTR
Entity Type:Organization
Organization Name:GATEWAY HEALTH CARE CENTRES LIMITED PTR
Other - Org Name:GATEWAY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DECAPITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-486-4949
Mailing Address - Street 1:23530 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2513
Mailing Address - Country:US
Mailing Address - Phone:216-486-4949
Mailing Address - Fax:216-481-5155
Practice Address - Street 1:3 GATEWAY DRIVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-2447
Practice Address - Country:US
Practice Address - Phone:216-486-4949
Practice Address - Fax:216-481-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5082314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0760145Medicaid
OH0760145Medicaid