Healthcare Provider Details

I. General information

NPI: 1265233027
Provider Name (Legal Business Name): GATEWAY COMMUNITY CHARTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5112 ARNOLD AVE STE A
MCCLELLAN CA
95652-1075
US

IV. Provider business mailing address

5112 ARNOLD AVE STE A
MCCLELLAN CA
95652-1075
US

V. Phone/Fax

Practice location:
  • Phone: 916-286-5129
  • Fax:
Mailing address:
  • Phone: 916-286-5129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON SAMPLE
Title or Position: SUPERINTENDENT/CEO
Credential:
Phone: 916-286-5129