Healthcare Provider Details

I. General information

NPI: 1720151137
Provider Name (Legal Business Name): GATEWAYS HOSPITAL & MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1891 EFFIE ST
LOS ANGELES CA
90026-1711
US

IV. Provider business mailing address

1891 EFFIE ST
LOS ANGELES CA
90026-1711
US

V. Phone/Fax

Practice location:
  • Phone: 323-644-2000
  • Fax: 323-953-6588
Mailing address:
  • Phone: 323-644-2000
  • Fax: 323-953-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number930000058
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PHIL K WONG
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PSY.D
Phone: 323-644-2000