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General NPI Number Information
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NPI Number | 1215462296
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Entity Type | Organization
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Legal Business Name | GATEWAY HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 3022 JAVIER RD SUITE # 207
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City | FAIRFAX
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State | VA
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Zip | 22031-4645
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Country | US
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Telephone | 703-462-8725
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Fax | 703-462-8726
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Provider Business Mailing Address
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Address Line | 3022 JAVIER RD SUITE # 207
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City | FAIRFAX
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State | VA
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Zip | 22031-4645
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Country | US
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Telephone | 703-462-8725
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. EMMANUEL OWUSU
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Credential |
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Telephone | 703-585-0531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCO-171543
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License Number State | VA
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