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General NPI Number Information
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NPI Number | 1124783477
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Entity Type | Organization
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Legal Business Name | GATEWAY COMMUNITY SERVICES, INC.
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 2133 BROADWAY AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32209-7513
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Country | US
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Telephone | 904-361-5010
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Fax | 904-384-2299
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Provider Business Mailing Address
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Address Line | 555 STOCKTON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-2534
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Country | US
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Telephone | 904-387-4661
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Fax | 904-389-8758
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Authorized Official
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Title or Position | CFO
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Name | JENNIFER VANZANDT
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Credential |
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Telephone | 904-387-4661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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