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General NPI Number Information
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NPI Number | 1780820480
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Entity Type | Organization
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Legal Business Name | GATEWAY TRUSTED CARE, LLC
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Dates
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Enumeration Date | 12/30/2008
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Last Update Date | 12/30/2008
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Provider Practice Location Address
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Address Line | 20600 CHAGRIN BLVD SUITE 600
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-5327
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Country | US
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Telephone | 216-491-8104
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Fax | 877-633-8329
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Provider Business Mailing Address
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Address Line | 20600 CHAGRIN BLVD SUITE 600
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-5327
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Country | US
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Telephone | 216-491-8104
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Fax | 877-633-8329
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Authorized Official
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Title or Position | CEO/PARTNER
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Name | MS. JEANNETTA BECOTE FULLER
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Credential | MSW, LSW
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Telephone | 216-491-8104
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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 |
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License Number State | OH
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