Healthcare Provider Details

I. General information

NPI: 1457406092
Provider Name (Legal Business Name): GATEWAY CHILDREN'S ADVOCACY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E MAIN ST
MOREHEAD KY
40351-1622
US

IV. Provider business mailing address

310 E MAIN ST
MOREHEAD KY
40351-1622
US

V. Phone/Fax

Practice location:
  • Phone: 606-780-7848
  • Fax: 606-780-0648
Mailing address:
  • Phone: 606-780-7848
  • Fax: 606-780-0648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRISH LEWIS
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 606-780-7848