Provider Demographics
NPI:1073502837
Name:GATEWAY AT FLORENCE REHABILITATION HOSPITAL, LLC
Entity Type:Organization
Organization Name:GATEWAY AT FLORENCE REHABILITATION HOSPITAL, LLC
Other - Org Name:GATEWAY REHABILITATION HOSPITAL AT FLORENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-426-2400
Mailing Address - Street 1:5940 MERCHANT DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1158
Mailing Address - Country:US
Mailing Address - Phone:859-426-2400
Mailing Address - Fax:859-426-2419
Practice Address - Street 1:5940 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1158
Practice Address - Country:US
Practice Address - Phone:859-426-2400
Practice Address - Fax:859-426-2419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100928283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY183030Medicare Oscar/Certification