Healthcare Provider Details

I. General information

NPI: 1548845928
Provider Name (Legal Business Name): GATEWAY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BARSTOW AVE
CLOVIS CA
93612-2225
US

IV. Provider business mailing address

111 BARSTOW AVE
CLOVIS CA
93612-2225
US

V. Phone/Fax

Practice location:
  • Phone: 559-554-2047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KEN EVANS
Title or Position: ADMINISTRATOR
Credential:
Phone: 559-299-2591