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General NPI Number Information
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NPI Number | 1265700538
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Entity Type | Organization
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Legal Business Name | GATEWAY SUPPORT SERVICES
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 20 FAIRVIEW RD
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City | GENEVA
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State | OH
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Zip | 44041-7118
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Country | US
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Telephone | 440-466-3942
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Fax | 440-466-0485
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Provider Business Mailing Address
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Address Line | 20 FAIRVIEW RD P.O. BOX 207
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City | GENEVA
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State | OH
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Zip | 44041-7118
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Country | US
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Telephone | 440-466-3942
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Fax | 440-466-0485
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM B AUSTIN
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Credential | LNHA
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Telephone | 440-466-3942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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