Provider Demographics
NPI:1114163888
Name:GATEWAY HOME CARE, LLC
Entity Type:Organization
Organization Name:GATEWAY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-974-3130
Mailing Address - Street 1:129 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1706
Mailing Address - Country:US
Mailing Address - Phone:681-342-3370
Mailing Address - Fax:304-482-1084
Practice Address - Street 1:150 PATRICK HENRY WAY
Practice Address - Street 2:CHARLES TOWN PLAZA
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-3852
Practice Address - Country:US
Practice Address - Phone:304-267-2599
Practice Address - Fax:304-267-1530
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-30
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810014781Medicaid
WV1306850002Medicare NSC