Healthcare Provider Details

I. General information

NPI: 1497748107
Provider Name (Legal Business Name): GATEWAY FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4049 MILLER WAY
SACRAMENTO CA
95817-1332
US

IV. Provider business mailing address

2921 FULTON AVE
SACRAMENTO CA
95821-4909
US

V. Phone/Fax

Practice location:
  • Phone: 916-451-9312
  • Fax: 916-451-4018
Mailing address:
  • Phone: 916-338-9460
  • Fax: 916-338-9468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number340003AN
License Number StateCA

VIII. Authorized Official

Name: MS. SUSAN B BLACKSHER
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 916-338-9460