Healthcare Provider Details

I. General information

NPI: 1750672242
Provider Name (Legal Business Name): GATEWAY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 NEW JESUP HWY
BRUNSWICK GA
31523-1629
US

IV. Provider business mailing address

3441 CYPRESS MILL RD SUITE 102
BRUNSWICK GA
31520-2878
US

V. Phone/Fax

Practice location:
  • Phone: 912-264-0979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: CFO
Phone: 912-554-8464