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General NPI Number Information
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NPI Number | 1023634862
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Entity Type | Organization
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Legal Business Name | GATEWAY RESIDENTIAL PROGRAMS WINDING HOUSE
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 7441 WINDING WAY
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City | FAIR OAKS
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State | CA
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Zip | 95628-6749
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Country | US
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Telephone | 916-966-1117
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Fax |
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Provider Business Mailing Address
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Address Line | 1780 VERNON ST STE 1
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City | ROSEVILLE
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State | CA
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Zip | 95678-6311
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Country | US
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Telephone | 916-782-1111
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Fax | 916-782-4544
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JEFF BEESLEY
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Credential | LMFT
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Telephone | 916-342-4818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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