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General NPI Number Information
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NPI Number | 1407431562
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Entity Type | Organization
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Legal Business Name | GATEHOUSE PSYCHIATRIC SOLUTIONS LLC
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Dates
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Enumeration Date | 03/10/2021
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 201 8TH AVE STE 12
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City | BARABOO
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State | WI
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Zip | 53913-2112
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Country | US
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Telephone | 608-434-2177
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 353
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City | BARABOO
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State | WI
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Zip | 53913-0353
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Country | US
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Telephone | 608-434-2177
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | JERRY C EXTEROVICH
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Credential |
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Telephone | 608-963-0674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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