Provider Demographics
NPI:1891202719
Name:GATEWAY PERSONAL CARE AGENCY LLC.
Entity Type:Organization
Organization Name:GATEWAY PERSONAL CARE AGENCY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:QUERIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-488-2224
Mailing Address - Street 1:5205 N IRONWOOD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4907
Mailing Address - Country:US
Mailing Address - Phone:414-488-2224
Mailing Address - Fax:
Practice Address - Street 1:5205 N IRONWOOD RD STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4907
Practice Address - Country:US
Practice Address - Phone:414-488-2224
Practice Address - Fax:855-320-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-30
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health