Healthcare Provider Details

I. General information

NPI: 1922425552
Provider Name (Legal Business Name): GATEWAYS RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4966 GLENWAY AVE
CINCINNATI OH
45238-3905
US

IV. Provider business mailing address

2600 VICTORY PKWY
CINCINNATI OH
45206-1711
US

V. Phone/Fax

Practice location:
  • Phone: 513-684-7955
  • Fax:
Mailing address:
  • Phone: 513-751-7747
  • Fax: 513-751-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateOH

VIII. Authorized Official

Name: MS. CARLA BROOKS
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 513-751-7747