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NPI Code Detail

MEDICARE: GATEWAY TO CHANGE

MEDICARE: GATEWAY TO CHANGE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency2479WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023281987
Entity Type Code : Organization
Provider Name (Legal Business Name) : GATEWAY TO CHANGE
Provider Business Mailing Address
First Line : 2319 W CAPITOL DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53206-1919
Country : US
Telephone Number : 414-442-2033
Fax Number : 414-442-2167
Provider Business Practice Location Address
First Line : 2319 W CAPITOL DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53206-1919
Country : US
Telephone Number : 414-442-2033
Fax Number : 414-442-2167
Authorized Official
Title or Position : EXECDUTIVE DIRECTOR
Name : MS. GLENDA O HAMPTON
Credential : SAC IT
Telephone Number : 414-442-2033
Provider Enumeration Date : 04/10/2008
Last Update Date : 04/10/2008

Similar Medicare Providers

1427194877 — MR. JAMES EDDIE MOORE CADC-III
Practice Location Address:
2319 W CAPITOL DR
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53206-1919
Practice Phone: 414-744-5370
Practice Fax: 414-744-9052
1770756801 — QUILLAN B GARRETT II MS CSW CSAC ICS
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1306126214 — GATEWAY TO CHANGE
Practice Location Address:
2319 W CAPITOL DR
MILWAUKEE, WI
53206-1919
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Practice Fax: 414-442-2167
1538440268 — CARLOS B ROBINSON SAC
Practice Location Address:
2319 W CAPITOL DR
MILWAUKEE, WI
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Practice Fax: 414-442-2176
1952679458 — GATEWAY TO CHANGE
Practice Location Address:
2319 W CAPITOL DR
MILWAUKEE, WI
53206-1919
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Practice Fax:
1174956635 — MRS. MARIA A MOORE ICS
Practice Location Address:
2319 W CAPITOL DR
MILWAUKEE, WI
53206-1919
Practice Phone: 414-442-2033
Practice Fax: 414-442-2167

Directions to “GATEWAY TO CHANGE ” Practice Location

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