Provider Demographics
NPI:1609149897
Name:GATEWAY REHABILITATION HOSPITAL, LLC
Entity Type:Organization
Organization Name:GATEWAY REHABILITATION HOSPITAL, LLC
Other - Org Name:GATEWAY REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFIER
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-621-6707
Mailing Address - Street 1:2200 ROSS AVE
Mailing Address - Street 2:SUITE 3060
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2708
Mailing Address - Country:US
Mailing Address - Phone:469-621-6707
Mailing Address - Fax:469-621-6678
Practice Address - Street 1:5940 MERCHANTS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1158
Practice Address - Country:US
Practice Address - Phone:859-426-2400
Practice Address - Fax:859-426-2419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
183030Medicare Oscar/Certification