Healthcare Provider Details

I. General information

NPI: 1124151980
Provider Name (Legal Business Name): GATEWAY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 BAYBRIDGE DR
BRUNSWICK GA
31525-1818
US

IV. Provider business mailing address

700 COASTAL VILLAGE DR
BRUNSWICK GA
31520-1974
US

V. Phone/Fax

Practice location:
  • Phone: 912-264-6065
  • Fax: 912-265-4520
Mailing address:
  • Phone: 912-264-0979
  • Fax: 912-264-5965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM PARKS
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA CFO
Phone: 912-554-8464