Provider Demographics
NPI:1073555272
Name:GATEWAY COMMUNITIES INC
Entity Type:Organization
Organization Name:GATEWAY COMMUNITIES INC
Other - Org Name:THE FOUNTAINS AT CEDAR PARKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECTUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-753-2000
Mailing Address - Street 1:7900 WESTPARK DR
Mailing Address - Street 2:T-900, ATTN: MEDICARE BILLING, M. GARCIA
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4242
Mailing Address - Country:US
Mailing Address - Phone:703-854-0823
Mailing Address - Fax:703-854-0164
Practice Address - Street 1:114 HAYES MILL RD
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-2457
Practice Address - Country:US
Practice Address - Phone:856-753-2000
Practice Address - Fax:856-809-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060419314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
315297Medicare ID - Type Unspecified