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General NPI Number Information
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NPI Number | 1164263893
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Entity Type | Organization
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Legal Business Name | GATEWAY FOUNDATION, INC. - BHC
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 3040 FINLEY RD STE 220
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5714
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Country | US
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Telephone | 877-381-6538
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Fax |
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Provider Business Mailing Address
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Address Line | 55 E JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60604-4466
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CONTRACTS AND CRED
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Name | JOSEPH ZIEBA
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Credential |
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Telephone | 312-502-1816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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