Healthcare Provider Details

I. General information

NPI: 1144331802
Provider Name (Legal Business Name): GATEWAY TO PREVENTION AND RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36609 45TH ST
SHAWNEE OK
74804-8882
US

IV. Provider business mailing address

36609 45TH ST
SHAWNEE OK
74804-8882
US

V. Phone/Fax

Practice location:
  • Phone: 405-273-1170
  • Fax: 405-275-5132
Mailing address:
  • Phone: 405-273-1170
  • Fax: 405-275-4412

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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JON GREENWOOD
Title or Position: CEO
Credential:
Phone: 405-273-1170