MEDICARE: GATEWAYS HOSPITAL AND MENTAL HEALTH CENTER

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	930000058	CA

General Provider Information

NPI Number	:	1033248257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAYS HOSPITAL AND MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	1891 EFFIE STREET
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026
Country	:	US
Telephone Number	:	323-644-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1338 S GRAND AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3009
Country	:	US
Telephone Number	:	213-389-5820
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARA PELSMAN
Credential	:
Telephone Number	:	323-644-2000

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	06/04/2024

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