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General NPI Number Information
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NPI Number | 1295699403
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Entity Type | Organization
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Legal Business Name | GREAT GATEWAY LL
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Dates
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Enumeration Date | 12/11/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 16145 VISTA WOODS CT
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-4538
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Country | US
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Telephone | 586-868-3337
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Fax |
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Provider Business Mailing Address
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Address Line | 16145 VISTA WOODS CT
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-4538
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Country | US
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Telephone | 586-868-3337
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANWAR Z NASSER
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Credential |
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Telephone | 586-868-3337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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