MEDICARE: GATEWAY FOUNDATION, INC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy
1	3245S0500X	Children's Substance Abuse Rehabilitation Facility
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	323P00000X	Psychiatric Residential Treatment Facility
4	324500000X	Substance Abuse Rehabilitation Facility

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

NPI Number	:	1386779445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY FOUNDATION, INC

Provider Business Mailing Address
First Line	:	55 E JACKSON BLVD
Second Line	:	SUITE 1500
City	:	CHICAGO
State	:	IL
Zip	:	60604-4466
Country	:	US
Telephone Number	:	312-663-1130
Fax Number	:	312-663-0504

Provider Business Practice Location Address
First Line	:	55 E JACKSON BLVD
Second Line	:	SUITE 1500
City	:	CHICAGO
State	:	IL
Zip	:	60604-4466
Country	:	US
Telephone Number	:	312-663-1130
Fax Number	:	312-663-0504

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	DR. THOMAS P BRITTON
Credential	:
Telephone Number	:	312-663-1130

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	11/15/2016

5600 W ADDISON ST STE 503
CHICAGO, IL
60634-4466

Practice Phone: 773-283-8664
Practice Fax: 773-283-8688