Provider Demographics
NPI:1568850378
Name:GATEWAY QUALITY HOME CARE LLC
Entity Type:Organization
Organization Name:GATEWAY QUALITY HOME CARE LLC
Other - Org Name:ASSISTED DAILY LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-273-2700
Mailing Address - Street 1:1360 S 5TH ST STE 356C
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2449
Mailing Address - Country:US
Mailing Address - Phone:636-206-7777
Mailing Address - Fax:636-724-4304
Practice Address - Street 1:1360 S 5TH ST STE 356C
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2449
Practice Address - Country:US
Practice Address - Phone:636-206-7777
Practice Address - Fax:636-724-4304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY QUALITY HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-31
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC9758094251E00000X
251F00000X, 253Z00000X, 291U00000X, 332B00000X, 343900000X, 347C00000X, 347E00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26D2254172OtherCLIA
MO700116807Medicaid