Healthcare Provider Details

I. General information

NPI: 1841291044
Provider Name (Legal Business Name): GATEWAY REHABILITATION CENTER-ERIE
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

1928 WAGER RD
ERIE PA
16509-4054
US

IV. Provider business mailing address

311 ROUSER RD
MOON TOWNSHIP PA
15108-2719
US

V. Phone/Fax

Practice location:
  • Phone: 814-825-0373
  • Fax: 814-825-0483
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 Number257067
License Number StatePA

VIII. Authorized Official

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