Healthcare Provider Details

I. General information

NPI: 1922473354
Provider Name (Legal Business Name): GATEWAY FOUNDATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SUNNYSIDE RD PICKETT BUILDING, 1ST FLOOR
SMYRNA DE
19977-1752
US

IV. Provider business mailing address

55 E JACKSON BLVD SUITE 1500
CHICAGO IL
60604-4466
US

V. Phone/Fax

Practice location:
  • Phone: 302-653-3923
  • Fax: 302-653-6044
Mailing address:
  • Phone: 312-663-1130
  • Fax: 312-663-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateDE

VIII. Authorized Official

Name: MR. THOMAS P BRITTON
Title or Position: PRESIDENT/CEO
Credential: DRPH,LPC,LCAS,CCS,AC
Phone: 312-663-1130