Healthcare Provider Details

I. General information

NPI: 1558424044
Provider Name (Legal Business Name): GATEWAY TO RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 LINTON BLVD SUITE 112
DELRAY BEACH FL
33444-8167
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 Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number0950AD1097491
License Number StateFL

VIII. Authorized Official

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