Healthcare Provider Details

I. General information

NPI: 1760279483
Provider Name (Legal Business Name): GATEWAY TO SUCCESS TRANSPORT TO WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
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: 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 Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

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