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NPI Code Detail

MEDICARE: GATEWAY HOMES, INC.

MEDICARE: GATEWAY HOMES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1323P00000XPsychiatric Residential Treatment Facility673-03-001VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154428290
Entity Type Code : Organization
Provider Name (Legal Business Name) : GATEWAY HOMES, INC.
Provider Business Mailing Address
First Line : 4905 DICKENS RD STE 106
Second Line :
City : RICHMOND
State : VA
Zip : 23230-1953
Country : US
Telephone Number : 571-550-0767
Fax Number : 804-269-5003
Provider Business Practice Location Address
First Line : 11901 REEDY BRANCH RD
Second Line :
City : CHESTERFIELD
State : VA
Zip : 23838-4235
Country : US
Telephone Number : 804-590-0828
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : LYNDA J HYATT
Credential : PH.D.
Telephone Number : 804-767-0292
Provider Enumeration Date : 09/20/2006
Last Update Date : 12/23/2021

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Directions to “GATEWAY HOMES, INC. ” Practice Location

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