Provider Demographics
NPI:1598752420
Name:GATEWAY,INC.
Entity Type:Organization
Organization Name:GATEWAY,INC.
Other - Org Name:D.B.A. GATEWAY CARE AND RETIREMENT CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-252-2461
Mailing Address - Street 1:39 NE 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4103
Mailing Address - Country:US
Mailing Address - Phone:503-252-2461
Mailing Address - Fax:503-408-5910
Practice Address - Street 1:39 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4103
Practice Address - Country:US
Practice Address - Phone:503-252-2461
Practice Address - Fax:503-408-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR800847314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR800847Medicaid
OR385268Medicare ID - Type Unspecified