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General NPI Number Information
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NPI Number | 1891969747
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Entity Type | Organization
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Legal Business Name | GATEWAY HEALTHCARE, INC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 1516 ATWOOD AVE
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City | JOHNSTON
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State | RI
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Zip | 02919-3223
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Country | US
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Telephone | 401-553-1000
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Fax | 401-553-1143
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Provider Business Mailing Address
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Address Line | 1516 ATWOOD AVE
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City | JOHNSTON
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State | RI
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Zip | 02919-3223
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Country | US
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Telephone | 401-553-1000
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Fax | 401-553-1143
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | JOYCE FACTEAU
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Credential |
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Telephone | 401-724-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | RI633
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License Number State | RI
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