Provider Demographics
NPI:1447443098
Name:GATE WAY HEALTH CARE ASSOCIATES
Entity type:Organization
Organization Name:GATE WAY HEALTH CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EALISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1910-844-2693
Mailing Address - Street 1:612 E DR MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-1800
Mailing Address - Country:US
Mailing Address - Phone:191-084-4269
Mailing Address - Fax:191-084-4269
Practice Address - Street 1:612 E DR MARTIN LUTHER KING JR DR
Practice Address - Street 2:612 MARTIN LUTHER KING DRIVE
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-1800
Practice Address - Country:US
Practice Address - Phone:910-844-2693
Practice Address - Fax:910-844-2694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY HEALTH CARE ASS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-27
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700525Medicaid