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General NPI Number Information
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NPI Number | 1952851602
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Entity Type | Organization
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Legal Business Name | GATES HEALTH CARE SERVICES, LLC
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 400 WALLACE CIR
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City | BLOOMINGDALE
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State | GA
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Zip | 31302-8050
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Country | US
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Telephone | 678-206-3553
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Fax | 912-965-0643
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Provider Business Mailing Address
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Address Line | 400 WALLACE CIR
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City | BLOOMINGDALE
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State | GA
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Zip | 31302-8050
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Country | US
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Telephone | 678-206-3553
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KIM STEELE
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Credential | MBA
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Telephone | 678-206-3553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State | GA
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