MEDICARE: GATEWAY QUALITY HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	LC9758094	MO
2	251F00000X	Home Infusion Agency
3	253Z00000X	In Home Supportive Care Agency
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	343900000X	Non-emergency Medical Transport (VAN)
6	347C00000X	Private Vehicle
7	347E00000X	Transportation Broker
8	385H00000X	Respite Care
9	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26D2254172	OTHER	MO	CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568850378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY QUALITY HOME CARE LLC

Provider Business Mailing Address
First Line	:	1360 S 5TH ST STE 356C
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2449
Country	:	US
Telephone Number	:	636-206-7777
Fax Number	:	636-724-4304

Provider Business Practice Location Address
First Line	:	1360 S 5TH ST STE 356C
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2449
Country	:	US
Telephone Number	:	636-206-7777
Fax Number	:	636-724-4304

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARAY L BROWN
Credential	:
Telephone Number	:	844-273-2700

Provider Enumeration Date	:	12/31/2014
Last Update Date	:	11/11/2022

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