Provider Demographics
NPI:1518953678
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/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARCELLONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-974-4200
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:833-988-4663
Mailing Address - Fax:304-842-1084
Practice Address - Street 1:179 E BURR BLVD STE N
Practice Address - Street 2:
Practice Address - City:KEARNEYSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25430-4964
Practice Address - Country:US
Practice Address - Phone:833-988-4663
Practice Address - Fax:304-842-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122692OtherMAMSI
441178OtherBS TRIGON
WV227376OtherADVANTRA FREEDOM COVENTRY
VA23745OtherCOMMUNITY HEALTH CHN
000223057OtherBS MT STATE
400237OtherBLACK LUNG
WV9100065000Medicaid
WV227376OtherADVANTRA FREEDOM COVENTRY
VA9102914Medicaid
000223057OtherBS MT STATE
2122692OtherMAMSI
400237OtherBLACK LUNG
=========OtherVA CENTER
WV9100065000Medicaid