Organization
GATEWAY HOME DIALYSIS, INC.
Active
Organization
GATEWAY HOME DIALYSIS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH HEANEY (ADMINISTRATOR)
(559) 733-9707
Entity
Organization
Contact information
Practice address
1120 N CHINOWTH ST, VISALIA, CA 93291-7896
(559) 733-9707
(559) 733-7009
Mailing address
1120 N CHINOWTH ST, VISALIA, CA 93291-7896
(559) 733-9707
(559) 733-7009
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
240000798
CA
332BD1200X
Dialysis Equipment & Supplies (DME)
FNP 18234
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4970860001
CIGNA MEDICARE DMERC
CA
05
—
CDC02771F
—
CA
Enumeration date
04/21/2006
Last updated
12/30/2009
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