Provider Demographics
NPI:1639164361
Name:GATE THREE HEALTHCARE LLC
Entity Type:Organization
Organization Name:GATE THREE HEALTHCARE LLC
Other - Org Name:PALM TERRACE HEALTHCARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:24962 CALLE ARAGON
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3883
Mailing Address - Country:US
Mailing Address - Phone:949-587-9000
Mailing Address - Fax:949-951-3174
Practice Address - Street 1:24962 CALLE ARAGON
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92637-3883
Practice Address - Country:US
Practice Address - Phone:949-587-9000
Practice Address - Fax:949-951-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000226314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55257GMedicaid
CALTC55257GMedicaid