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General NPI Number Information
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NPI Number | 1003377011
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Entity Type | Organization
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Legal Business Name | GATEWAY RECOVERY CLINIC, PLLC
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Dates
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Enumeration Date | 03/31/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 805 ALEXA DR STE D
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City | MT STERLING
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State | KY
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Zip | 40353-1000
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Country | US
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Telephone | 859-432-8002
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Fax |
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Provider Business Mailing Address
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Address Line | 805 ALEXA DR STE D
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City | MT STERLING
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State | KY
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Zip | 40353-1000
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Country | US
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Telephone | 859-432-8002
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SARAH ZALONE
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Credential | DO
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Telephone | 859-432-8002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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