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General NPI Number Information
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NPI Number | 1255606810
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Entity Type | Organization
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Legal Business Name | GATEWAY BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 03/15/2012
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 700 COASTAL VILLAGE DR
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City | BRUNSWICK
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State | GA
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Zip | 31520-1974
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Country | US
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Telephone | 912-554-8510
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Fax |
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Provider Business Mailing Address
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Address Line | 6055 NEW JESUP HWY
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City | BRUNSWICK
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State | GA
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Zip | 31523-1629
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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 REIMBURSEMENT
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Name | MRS. RACHEL N SKINNER
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Credential |
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Telephone | 912-554-8498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | CLA000894
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License Number State | GA
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