Healthcare Provider Details

I. General information

NPI: 1982151742
Provider Name (Legal Business Name): GATEWAY TO VETERANS SERVICES FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 CHICAGO AVE A13
RIVERSIDE CA
92507-2206
US

IV. Provider business mailing address

5198 ARLINGTON AVE SUITE 342
RIVERSIDE CA
92504-2603
US

V. Phone/Fax

Practice location:
  • Phone: 951-823-0175
  • Fax: 951-823-0106
Mailing address:
  • Phone: 951-823-0175
  • Fax: 951-823-0106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: ALFREDO MADRID
Title or Position: VICE PRESIDENT
Credential:
Phone: 951-823-0175