Provider Demographics
NPI:1730136128
Name:GATEWAY HEALTHCARE LLC
Entity Type:Organization
Organization Name:GATEWAY HEALTHCARE LLC
Other - Org Name:GATEWAY REHABILITATION AND HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:USSERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-571-1550
Mailing Address - Street 1:2030 HARPER AVE NW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-4953
Mailing Address - Country:US
Mailing Address - Phone:828-754-3888
Mailing Address - Fax:828-754-4068
Practice Address - Street 1:2030 HARPER AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4953
Practice Address - Country:US
Practice Address - Phone:828-754-3888
Practice Address - Fax:828-754-4068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0485314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1730136128Medicaid
NC3425329Medicaid
NC7805126Medicaid
NC7805126Medicaid