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General NPI Number Information
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NPI Number | 1477179166
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Entity Type | Organization
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Legal Business Name | GATEWAY RECOVERY HOUSE, INC.
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Dates
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Enumeration Date | 06/18/2020
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 30 GEORGE ST
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City | TORRINGTON
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State | CT
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Zip | 06790-5436
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Country | US
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Telephone | 203-510-1762
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Fax |
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Provider Business Mailing Address
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Address Line | 128 CAPEWELL AVE
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City | OAKVILLE
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State | CT
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Zip | 06779-2304
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Country | US
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Telephone | 203-510-1762
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JAMIE ROGERS
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Credential |
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Telephone | 203-510-1762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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