Healthcare Provider Details

I. General information

NPI: 1386779445
Provider Name (Legal Business Name): GATEWAY FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 312-663-1130
  • Fax: 312-663-0504
Mailing address:
  • Phone: 312-663-1130
  • Fax: 312-663-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS P BRITTON
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 312-663-1130