MEDICARE: GATEWAYS TO TRANSFORMATION LLC

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	310500000X	Mental Illness Intermediate Care Facility
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1386275469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAYS TO TRANSFORMATION LLC

Provider Business Mailing Address
First Line	:	4874 GATEWAY RD
Second Line	:
City	:	CRAWFORD
State	:	CO
Zip	:	81415-8929
Country	:	US
Telephone Number	:	303-859-7385
Fax Number	:	970-921-5420

Provider Business Practice Location Address
First Line	:	4874 GATEWAY RD
Second Line	:
City	:	CRAWFORD
State	:	CO
Zip	:	81415-8929
Country	:	US
Telephone Number	:	303-859-7385
Fax Number	:	970-921-5420

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. ALISHA M ADRIAN
Credential	:	COUNSELOR
Telephone Number	:	303-859-7385

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	07/19/2022

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Directions to “GATEWAYS TO TRANSFORMATION LLC ” Practice Location

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