Provider Demographics
NPI:1780820480
Name:GATEWAY TRUSTED CARE, LLC
Entity type:Organization
Organization Name:GATEWAY TRUSTED CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNETTA
Authorized Official - Middle Name:BECOTE
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW
Authorized Official - Phone:216-491-8104
Mailing Address - Street 1:20600 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5327
Mailing Address - Country:US
Mailing Address - Phone:216-491-8104
Mailing Address - Fax:877-633-8329
Practice Address - Street 1:20600 CHAGRIN BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5327
Practice Address - Country:US
Practice Address - Phone:216-491-8104
Practice Address - Fax:877-633-8329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health