Provider Demographics
NPI:1730528795
Name:GATEWAY MANOR
Entity type:Organization
Organization Name:GATEWAY MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-576-6069
Mailing Address - Street 1:8320 14TH WAY N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2838
Mailing Address - Country:US
Mailing Address - Phone:727-576-6069
Mailing Address - Fax:727-289-7729
Practice Address - Street 1:8320 14TH WAY N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2838
Practice Address - Country:US
Practice Address - Phone:727-576-6069
Practice Address - Fax:727-289-7729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-22
Last Update Date:2013-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9604310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility