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NPI Code Detail

MEDICARE: GATEWAYS HOSPITAL & MENTAL HEALTH CENTER

MEDICARE: GATEWAYS HOSPITAL & MENTAL HEALTH CENTER
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 Facility191800257CA
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1497884613
Entity Type Code : Organization
Provider Name (Legal Business Name) : GATEWAYS HOSPITAL & MENTAL HEALTH CENTER
Provider Business Mailing Address
First Line : 1891 EFFIE STREET
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026
Country : US
Telephone Number : 323-644-2000
Fax Number : 323-315-1169
Provider Business Practice Location Address
First Line : 320 N MADISON AVE STE B
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-3791
Country : US
Telephone Number : 323-644-2040
Fax Number : 323-660-6866
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. PHIL WONG
Credential : PSY. D
Telephone Number : 323-644-2000
Provider Enumeration Date : 03/05/2007
Last Update Date : 03/16/2022

Similar Medicare Providers

1700334992 — GATEWAYS HOSPITAL & MENTAL HEALTH CENTER
Practice Location Address:
320 N MADISON AVE STE B
LOS ANGELES, CA
90004-3791
Practice Phone: 323-644-2026
Practice Fax:
1609036516 — CHRISTA NICHELL NETTLES
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1679228985 — ANTHONY BERRIOS
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Practice Fax:
1235853722 — JIAYI YANG
Practice Location Address:
320 N MADISON AVE STE B
LOS ANGELES, CA
90004-3791
Practice Phone: 646-749-4542
Practice Fax:
1568200368 — CRYSTAL KELLEY
Practice Location Address:
320 N MADISON AVE STE B
LOS ANGELES, CA
90004-3791
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Practice Fax:
1558187351 — MS. RYEISHA SHAWNTAE MOORE-NASH
Practice Location Address:
320 N MADISON AVE STE B
LOS ANGELES, CA
90004-3791
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Practice Fax:

Directions to “GATEWAYS HOSPITAL & MENTAL HEALTH CENTER ” Practice Location

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