Provider Demographics
NPI:1154865103
Name:GATEWAY SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:GATEWAY SUPPORT SERVICES, INC.
Other - Org Name:GATEWAY SUPPORT SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-857-5084
Mailing Address - Street 1:5508 N 50TH ST STE 20-A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5508 N 50TH ST STE 20-A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4804
Practice Address - Country:US
Practice Address - Phone:813-857-5084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESIDENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-09
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251E00000XMedicaid