Healthcare Provider Details

I. General information

NPI: 1750681821
Provider Name (Legal Business Name): GATEWAY COMMUNITY SUPPORT SYSTEMS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2010
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 SALLIOTTE RD
ECORSE MI
48229-1752
US

IV. Provider business mailing address

28 SALLIOTTE RD
ECORSE MI
48229-1752
US

V. Phone/Fax

Practice location:
  • Phone: 888-610-2217
  • Fax: 734-818-1438
Mailing address:
  • Phone: 888-610-2217
  • Fax: 734-818-1438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. APRIL EXANDRA CAIN
Title or Position: OWNER
Credential:
Phone: 734-558-6788