Healthcare Provider Details

I. General information

NPI: 1477144756
Provider Name (Legal Business Name): GATEWAY TO SUCCESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/08/2021
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 1748
CANON CITY CO
81215-1748
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-0700
  • Fax: 719-896-2874
Mailing address:
  • Phone: 719-275-0700
  • Fax: 719-896-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KAREN S MORGENTHALER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 719-275-0700