1124485149 NPI number — GATEWAY REHABILITATION CENTER

Table of content: LISANDRA GONZALEZ REY (NPI 1104660091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124485149 NPI number — GATEWAY REHABILITATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GATEWAY REHABILITATION CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124485149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 ROUSER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOON TOWNSHIP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15108-6801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-604-8900
Provider Business Mailing Address Fax Number:
412-299-8751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 S CHURCH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-604-8900
Provider Business Practice Location Address Fax Number:
412-299-8751
Provider Enumeration Date:
01/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
TROUP
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
412-604-8900

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  657055 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007607430099 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007607430100 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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