Healthcare Provider Details

I. General information

NPI: 1043211246
Provider Name (Legal Business Name): GATEWAY REHABILITATION CENTER-BRADDOCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 GEORGE ST
BRADDOCK PA
15104-1606
US

IV. Provider business mailing address

311 ROUSER RD
MOON TOWNSHIP PA
15108-2719
US

V. Phone/Fax

Practice location:
  • Phone: 412-351-3548
  • Fax: 412-351-3581
Mailing address:
  • Phone: 412-604-8900
  • Fax: 412-299-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007607430069
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. JAMES TROUP
Title or Position: PRESIDENT/CEO
Credential:
Phone: 412-604-8900