Healthcare Provider Details

I. General information

NPI: 1235530650
Provider Name (Legal Business Name): GATEWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CYPRESS LN
GRANITE FALLS NC
28630-1440
US

IV. Provider business mailing address

120 CYPRESS LN
GRANITE FALLS NC
28630-1440
US

V. Phone/Fax

Practice location:
  • Phone: 828-455-1997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4106
License Number StateNC

VIII. Authorized Official

Name: WENDY ABEE
Title or Position: PTA
Credential:
Phone: 828-455-1997