Provider Demographics
NPI:1598202871
Name:GATEWAY COMMUNITY HEALTH CENTERS, INC
Entity Type:Organization
Organization Name:GATEWAY COMMUNITY HEALTH CENTERS, INC
Other - Org Name:GATEWAY COMMUNITY HEALTH CENTERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-221-2171
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27938-0297
Mailing Address - Country:US
Mailing Address - Phone:252-221-1033
Mailing Address - Fax:
Practice Address - Street 1:2869 VIRGINIA RD
Practice Address - Street 2:
Practice Address - City:TYNER
Practice Address - State:NC
Practice Address - Zip Code:27980
Practice Address - Country:US
Practice Address - Phone:252-221-1033
Practice Address - Fax:252-221-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12942333600000X
3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC27315OtherNCBP
2167304OtherPK