Provider Demographics
NPI:1457539215
Name:GATEWAY BUILDING SUPPLY INC
Entity Type:Organization
Organization Name:GATEWAY BUILDING SUPPLY INC
Other - Org Name:CITYWIDE REMODELLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-249-3083
Mailing Address - Street 1:8515 DOUGLAS AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2924
Mailing Address - Country:US
Mailing Address - Phone:515-249-3083
Mailing Address - Fax:515-251-4817
Practice Address - Street 1:8515 DOUGLAS AVE STE 15
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2924
Practice Address - Country:US
Practice Address - Phone:515-249-3083
Practice Address - Fax:515-251-4817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0763342Medicaid