Provider Demographics
NPI:1104379007
Name:MDH GATEWAY, LLC
Entity Type:Organization
Organization Name:MDH GATEWAY, LLC
Other - Org Name:LOVED ONES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:XIA
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-770-9234
Mailing Address - Street 1:12735 SKYKNOLL LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-5329
Mailing Address - Country:US
Mailing Address - Phone:832-770-9234
Mailing Address - Fax:832-486-9851
Practice Address - Street 1:11111 RICHMOND AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-6665
Practice Address - Country:US
Practice Address - Phone:832-770-9234
Practice Address - Fax:832-486-9851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3653651Medicaid