MEDICARE: GATEWAY FAMILY HOUSE, 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	310400000X	Assisted Living Facility	2416R	OH

General Provider Information

NPI Number	:	1801286281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY FAMILY HOUSE, LLC

Provider Business Mailing Address
First Line	:	29225 CHAGRIN BLVD STE 230
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44122-4632
Country	:	US
Telephone Number	:	440-658-1040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GATEWAY
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44119-2447
Country	:	US
Telephone Number	:	216-531-5400
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ELI M GUNZBURG
Credential	:
Telephone Number	:	440-658-1040

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	01/23/2015

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