Healthcare Provider Details

I. General information

NPI: 1972968121
Provider Name (Legal Business Name): GATEWAY FOUNDATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3828 W TAYLOR ST
CHICAGO IL
60624-4027
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 773-826-1916
  • Fax: 773-826-2707
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 TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS P BRITTON
Title or Position: PRESIDENT/CEO
Credential: DRPH, LPC, LCAS, CCS
Phone: 312-663-1130