MEDICARE: GATEWAY HORSEWORKS

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1316674286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY HORSEWORKS

Provider Business Mailing Address
First Line	:	2045 UNION HILL RD
Second Line	:
City	:	MALVERN
State	:	PA
Zip	:	19355-7602
Country	:	US
Telephone Number	:	484-433-9911
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 UNION HILL RD
Second Line	:
City	:	MALVERN
State	:	PA
Zip	:	19355-7602
Country	:	US
Telephone Number	:	484-433-9911
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KRISTEN DE MARCO
Credential	:
Telephone Number	:	484-433-9911

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/02/2022

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Directions to “GATEWAY HORSEWORKS ” Practice Location

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