Healthcare Provider Details

I. General information

NPI: 1184753709
Provider Name (Legal Business Name): GATEWAY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E INDUSTRIAL BLVD
PEMBROKE GA
31321
US

IV. Provider business mailing address

700 COASTAL VILLAGE DR
BRUNSWICK GA
31520-1974
US

V. Phone/Fax

Practice location:
  • Phone: 912-653-4151
  • Fax: 912-653-2886
Mailing address:
  • Phone: 912-264-0979
  • Fax: 912-264-5965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: WENDY HUGHES
Title or Position: CFO
Credential:
Phone: 912-544-8510