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General NPI Number Information
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NPI Number | 1316105042
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Entity Type | Organization
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Legal Business Name | GATE WAY HEALTH CARE ASSOCIATES LLC
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 201 MARTIN LUTHER KING DR
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City | BLADENBORO
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State | NC
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Zip | 28320
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Country | US
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Telephone | 910-536-5749
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Fax |
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Provider Business Mailing Address
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Address Line | 201 MARTIN LUTHER KING DR PO BOX 1463
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City | BLADENBORO
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State | NC
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Zip | 28320
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Country | US
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Telephone | 910-536-5749
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MS. EALISE HUNT
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Credential | BSW
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Telephone | 910-536-5749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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