Healthcare Provider Details

I. General information

NPI: 1427934777
Provider Name (Legal Business Name): GATEWAY TO SUCCESS RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 YALE PL
CANON CITY CO
81212-4611
US

IV. Provider business mailing address

PO BOX 7271
WOODLAND PARK CO
80863-0203
US

V. Phone/Fax

Practice location:
  • Phone: 195-645-0707
  • Fax: 719-896-2874
Mailing address:
  • Phone: 719-564-5070
  • Fax: 719-896-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY KELLY
Title or Position: DIRECTOR OF FINANCE AND HR
Credential:
Phone: 719-564-5070