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General NPI Number Information
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NPI Number | 1801390950
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Entity Type | Organization
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Legal Business Name | GATEWAY PROGRAM, LLC
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 3117 11 1/2 AVE NW
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City | ROCHESTER
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State | MN
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Zip | 55901-1474
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Country | US
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Telephone | 507-244-1303
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Fax |
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Provider Business Mailing Address
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Address Line | 3117 11 1/2 AVE NW
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City | ROCHESTER
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State | MN
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Zip | 55901-1474
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Country | US
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Telephone | 507-244-1303
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ERIC JOHN SPAGENSKI
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Credential | LICSW
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Telephone | 507-244-1303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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