Healthcare Provider Details

I. General information

NPI: 1902456999
Provider Name (Legal Business Name): GATEWAY FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4028 W. DEMPSTER, STE 100
SKOKIE IL
60076
US

IV. Provider business mailing address

55 E JACKSON BLVD STE 1500
CHICAGO IL
60604-4184
US

V. Phone/Fax

Practice location:
  • Phone: 877-505-4673
  • Fax:
Mailing address:
  • Phone: 678-445-4833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENEE ENNIS MCGEE
Title or Position: MANAGER
Credential:
Phone: 678-445-4833