1699769323 NPI number — GATEWAY CARE CENTER, LLC

Table of content: (NPI 1699769323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699769323 NPI number — GATEWAY CARE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GATEWAY CARE CENTER, LLC
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:
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:
1699769323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
139 GRANT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EATONTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07724-1306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-542-4700
Provider Business Mailing Address Fax Number:
732-542-4747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 GRANT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATONTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07724-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-542-4700
Provider Business Practice Location Address Fax Number:
732-542-4747
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DARLINGTON
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
732-542-4700

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  061305 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4489900 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: A546100 . This is a "OXFORD PROVIDER NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: IL9946 . This is a "PHS/HEALTHNET PROVIDER NU" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3124459 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 009565 . This is a "EMPIRE PROVIDER NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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