Healthcare Provider Details

I. General information

NPI: 1154865103
Provider Name (Legal Business Name): GATEWAY SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5508 N 50TH ST STE 20-A
TAMPA FL
33610-4804
US

IV. Provider business mailing address

5508 N 50TH ST STE 20-A
TAMPA FL
33610-4804
US

V. Phone/Fax

Practice location:
  • Phone: 813-857-5084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: TAMEKA ONEAL
Title or Position: PRESIDENT
Credential:
Phone: 813-857-5084