Healthcare Provider Details

I. General information

NPI: 1497884613
Provider Name (Legal Business Name): GATEWAYS HOSPITAL & MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N MADISON AVE STE B
LOS ANGELES CA
90004-3791
US

IV. Provider business mailing address

1891 EFFIE STREET
LOS ANGELES CA
90026
US

V. Phone/Fax

Practice location:
  • Phone: 323-644-2040
  • Fax: 323-660-6866
Mailing address:
  • Phone: 323-644-2000
  • Fax: 323-315-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number191800257
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

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