Provider Demographics
NPI:1346911724
Name:GATEWAY HOME HEALTH TUCSON LLC
Entity Type:Organization
Organization Name:GATEWAY HOME HEALTH TUCSON LLC
Other - Org Name:GATEWAY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SUOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-251-4242
Mailing Address - Street 1:3636 NOBEL DR STE 450
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1062
Mailing Address - Country:US
Mailing Address - Phone:858-251-4242
Mailing Address - Fax:
Practice Address - Street 1:333 E WETMORE RD STE 325
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1742
Practice Address - Country:US
Practice Address - Phone:520-407-6228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health