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General NPI Number Information
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NPI Number | 1164014866
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Entity Type | Organization
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Legal Business Name | GATEWAY TO SUCCESS
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Dates
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Enumeration Date | 02/04/2021
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 3493 CRAIG AVE
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City | CINCINNATI
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State | OH
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Zip | 45211-5727
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Country | US
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Telephone | 513-225-9609
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Fax | 513-813-3032
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Provider Business Mailing Address
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Address Line | 3493 CRAIG AVE
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City | CINCINNATI
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State | OH
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Zip | 45211-5727
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Country | US
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Telephone | 513-225-9609
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Fax | 513-813-3032
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. DETRA JETT
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Credential |
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Telephone | 513-225-9609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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