Provider Demographics
NPI:1851392773
Name:GATEWAY HEALTH & REHAB, LLC
Entity Type:Organization
Organization Name:GATEWAY HEALTH & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:706-378-0940
Mailing Address - Street 1:3201 WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-5851
Mailing Address - Country:US
Mailing Address - Phone:706-865-5686
Mailing Address - Fax:706-865-6929
Practice Address - Street 1:3201 WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-5851
Practice Address - Country:US
Practice Address - Phone:706-865-5686
Practice Address - Fax:706-865-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-154-1805314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00140786AMedicaid
GA115560Medicare Oscar/Certification