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General NPI Number Information
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NPI Number | 1558424044
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Entity Type | Organization
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Legal Business Name | GATEWAY TO RECOVERY INC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 660 LINTON BLVD SUITE 112
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City | DELRAY BEACH
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State | FL
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Zip | 33444-8167
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Country | US
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Telephone | 561-265-4031
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Fax | 561-265-4091
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Provider Business Mailing Address
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Address Line | 660 LINTON BLVD SUITE 112
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City | DELRAY BEACH
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State | FL
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Zip | 33444-8167
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Country | US
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Telephone | 561-265-4031
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Fax | 561-265-4091
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Authorized Official
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Title or Position | CEO PROGRAM DIRECTOR
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Name | MR. MICHAEL MELICHAR
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Credential |
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Telephone | 561-265-4031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 0950AD1097491
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License Number State | FL
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