Provider Demographics
NPI:1174951230
Name:GATEWAY ANGEL'S
Entity type:Organization
Organization Name:GATEWAY ANGEL'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:561-420-4967
Mailing Address - Street 1:307 NE 24 AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435
Mailing Address - Country:US
Mailing Address - Phone:561-420-4967
Mailing Address - Fax:
Practice Address - Street 1:307 NE 24TH AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-2134
Practice Address - Country:US
Practice Address - Phone:561-420-4967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home