Organization Name:  GATEWAY HOME DIALYSIS, INC.


Practice Location:
1120 N CHINOWTH ST  VISALIA, CA 93291 US
Tel: 559-733-9707  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	332BD1200X	Suppliers Durable Medical Equipment & Medical Supplies Dialysis Equipment & Supplies	CA	FNP 18234
Y	261QE0700X	Ambulatory Health Care Facilities Clinic/Center	CA	240000798

Other Provider Identifiers:

Issuer	Number	State	Type
CIGNA MEDICARE DMERC	4970860001	CA	01
	CDC02771F	CA	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin