Healthcare Provider Details

I. General information

NPI: 1720250269
Provider Name (Legal Business Name): GATEWAY BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 BONAVENTURE RD
THUNDERBOLT GA
31404-3299
US

IV. Provider business mailing address

700 COASTAL VILLAGE DR
BRUNSWICK GA
31520-1974
US

V. Phone/Fax

Practice location:
  • Phone: 912-790-6526
  • Fax: 912-790-3460
Mailing address:
  • Phone: 912-554-8510
  • 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
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID CREWS
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 912-554-8464