Healthcare Provider Details

I. General information

NPI: 1477587871
Provider Name (Legal Business Name): GATEWAY HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 ROOSEVELT AVE SUITE 205
PAWTUCKET RI
02860-2134
US

IV. Provider business mailing address

101 BACON ST
PAWTUCKET RI
02860-5542
US

V. Phone/Fax

Practice location:
  • Phone: 401-724-8400
  • Fax: 401-365-1100
Mailing address:
  • Phone: 401-722-3560
  • Fax: 401-724-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberRN35771
License Number StateRI

VIII. Authorized Official

Name: JOYCE FACTEAU
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 401-724-8400