MEDICARE: GATEWAY TRANSITION CENTER, 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	251V00000X	Voluntary or Charitable Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1942751557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY TRANSITION CENTER, INC.

Provider Business Mailing Address
First Line	:	10510 JOOR RD
Second Line	:	SUITE 100
City	:	BATON ROUGE
State	:	LA
Zip	:	70818-3900
Country	:	US
Telephone Number	:	225-590-3124
Fax Number	:

Provider Business Practice Location Address
First Line	:	10510 JOOR RD
Second Line	:	SUITE 100
City	:	BATON ROUGE
State	:	LA
Zip	:	70818-3900
Country	:	US
Telephone Number	:	225-590-3124
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN WHITLOW
Credential	:
Telephone Number	:	225-590-3168

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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