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General NPI Number Information
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NPI Number | 1235901141
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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 | 10/24/2023
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Last Update Date | 10/24/2023
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Provider Practice Location 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 | 904-361-5005
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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 | 904-361-5005
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Authorized Official
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Title or Position | UR/INSURANCE SPECIALIST
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Name | SHAWANDA HOLLOWAY
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Credential | LMHC, MCAP
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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