MEDICARE: GATEWAY FOUNDATION, INC.

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	324500000X	Substance Abuse Rehabilitation Facility	C/A-0538-0029-A	IL

General Provider Information

NPI Number	:	1336398874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY FOUNDATION, INC.

Provider Business Mailing Address
First Line	:	55 E JACKSON BLVD
Second Line	:	SUITE 1500
City	:	CHICAGO
State	:	IL
Zip	:	60604-4466
Country	:	US
Telephone Number	:	312-663-1130
Fax Number	:	312-663-0504

Provider Business Practice Location Address
First Line	:	3828 W TAYLOR ST
Second Line	:	1ST, 2ND, 3RD FLOORS
City	:	CHICAGO
State	:	IL
Zip	:	60624-4027
Country	:	US
Telephone Number	:	773-826-1916
Fax Number	:	773-826-2707

Authorized Official
Title or Position	:	MANAGER
Name	:	RENEE ENNIS MCGEE
Credential	:
Telephone Number	:	678-445-4833

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	12/16/2021

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