Healthcare Provider Details

I. General information

NPI: 1386275469
Provider Name (Legal Business Name): GATEWAYS TO TRANSFORMATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4874 GATEWAY RD
CRAWFORD CO
81415-8929
US

IV. Provider business mailing address

4874 GATEWAY RD
CRAWFORD CO
81415-8929
US

V. Phone/Fax

Practice location:
  • Phone: 303-859-7385
  • Fax: 970-921-5420
Mailing address:
  • Phone: 303-859-7385
  • Fax: 970-921-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ALISHA M ADRIAN
Title or Position: EXECUTIVE DIRECTOR
Credential: COUNSELOR
Phone: 303-859-7385