MEDICARE: GATEWAY HOUSING FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		MO

General Provider Information

NPI Number	:	1952671109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY HOUSING FOUNDATION

Provider Business Mailing Address
First Line	:	1400 SALISBURY ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63107-2939
Country	:	US
Telephone Number	:	314-231-9608
Fax Number	:	314-231-1660

Provider Business Practice Location Address
First Line	:	1400 SALISBURY AVE, 2ND FL
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63107-2928
Country	:	US
Telephone Number	:	314-231-9608
Fax Number	:	314-231-1660

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	MR. MAURICE MCINTOSH
Credential	:
Telephone Number	:	314-769-6623

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	01/05/2012

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