Healthcare Provider Details

I. General information

NPI: 1326234519
Provider Name (Legal Business Name): GATEWAY DETOXIFICATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SE 23RD AVE
BOYNTON BEACH FL
33435-7289
US

IV. Provider business mailing address

660 LINTON BLVD SUITE 112
DELRAY BEACH FL
33444-8167
US

V. Phone/Fax

Practice location:
  • Phone: 561-265-4031
  • Fax: 561-265-4091
Mailing address:
  • Phone: 561-265-4031
  • Fax: 561-265-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL A MELICHAR
Title or Position: CEO/PROGRAM DIRECTOR
Credential:
Phone: 561-265-4031