Healthcare Provider Details

I. General information

NPI: 1639588338
Provider Name (Legal Business Name): GATEWAY DETROIT EAST COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11457 SHOEMAKER ST
DETROIT MI
48213
US

IV. Provider business mailing address

11457 SHOEMAKER ST
DETROIT MI
48213
US

V. Phone/Fax

Practice location:
  • Phone: 313-331-3435
  • Fax:
Mailing address:
  • Phone: 313-331-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YOLANDA JAMES
Title or Position: RN
Credential:
Phone: 313-331-3435