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General NPI Number Information
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NPI Number | 1740313501
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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 | 03/13/2007
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 1915 EAST 51ST STREET
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City | SAVANNAH
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State | GA
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Zip | 31404
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Country | US
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Telephone | 912-353-3089
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Fax | 912-351-6490
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Provider Business Mailing Address
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Address Line | 3441 CYPRESS MILL ROAD SUITE 2
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City | BRUNSWICK
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State | GA
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Zip | 31520
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Country | US
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Telephone | 912-264-0979
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Fax | 912-437-9481
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. WILLIAM PARKS
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Credential | CPA CFO
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Telephone | 912-554-8464
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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 | 025011408
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License Number State | GA
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