Provider Demographics
NPI:1396827317
Name:GATEWAY HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:GATEWAY HEALTH SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AJIBOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AYENI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:708-754-9674
Mailing Address - Street 1:2902 ALEXANDER CRES
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1704
Mailing Address - Country:US
Mailing Address - Phone:708-754-9674
Mailing Address - Fax:708-754-9796
Practice Address - Street 1:222 VOLLMER RD
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1664
Practice Address - Country:US
Practice Address - Phone:708-754-9674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010178251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010178OtherSTATE AGENCY LICENSE NUMB
IL1010178OtherSTATE AGENCY LICENSE NUMB