Healthcare Provider Details

I. General information

NPI: 1114176401
Provider Name (Legal Business Name): GATEWAY FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MERCY LN
AURORA IL
60506-2447
US

IV. Provider business mailing address

55 E JACKSON BLVD SUITE 1500
CHICAGO IL
60604-4466
US

V. Phone/Fax

Practice location:
  • Phone: 630-966-7600
  • Fax: 630-966-8565
Mailing address:
  • Phone: 312-663-1130
  • Fax: 312-663-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number04149
License Number StateIL

VIII. Authorized Official

Name: MR. MICHAEL DARCY
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 312-663-1130