MEDICARE: ARC GATEWAY, 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
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1649249384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARC GATEWAY, INC.

Provider Business Mailing Address
First Line	:	3932 N. 1OTH AVENUE
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503
Country	:	US
Telephone Number	:	850-434-2638
Fax Number	:	850-438-2180

Provider Business Practice Location Address
First Line	:	3932 N. 1OTH AVENUE
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503
Country	:	US
Telephone Number	:	850-434-2638
Fax Number	:	850-438-2180

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. DONNA FASSETT
Credential	:
Telephone Number	:	850-434-2638

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	09/11/2025

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