Healthcare Provider Details

I. General information

NPI: 1881891356
Provider Name (Legal Business Name): GATEWAY COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 W GRAND BLVD FL 20 SUITE 2000
DETROIT MI
48202-3022
US

IV. Provider business mailing address

3011 W GRAND BLVD FL 20 SUITE 2000
DETROIT MI
48202-3022
US

V. Phone/Fax

Practice location:
  • Phone: 313-262-5100
  • Fax: 313-875-4715
Mailing address:
  • Phone: 313-262-5100
  • Fax: 313-875-4715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MR. MITCHELL HALL
Title or Position: CEO
Credential:
Phone: 313-263-2360