Provider Demographics
NPI:1952699985
Name:GATEWAY HEALTHCARE, INC
Entity Type:Organization
Organization Name:GATEWAY HEALTHCARE, INC
Other - Org Name:DEVELOPMENT DISABILITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF RECEIVABLES
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-724-8400
Mailing Address - Street 1:249 ROOSEVELT AVE
Mailing Address - Street 2:SUITE 249
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-2134
Mailing Address - Country:US
Mailing Address - Phone:401-724-8400
Mailing Address - Fax:401-722-5039
Practice Address - Street 1:249 ROOSEVELT AVE
Practice Address - Street 2:SUITE 249
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-2134
Practice Address - Country:US
Practice Address - Phone:401-724-8400
Practice Address - Fax:401-722-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI633251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH78991Medicaid