MEDICARE: GATEWAY FOUNDATION, 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	A-0538-0026-A	IL
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	A-0538-0026-A	IL
3	324500000X	Substance Abuse Rehabilitation Facility	C/A-0538-0026	IL

General Provider Information

NPI Number	:	1821360066
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	:	3828 W TAYLOR ST
Second Line	:	MAIN CENTER
City	:	CHICAGO
State	:	IL
Zip	:	60624-4027
Country	:	US
Telephone Number	:	877-505-4673
Fax Number	:	773-826-2707

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. THOMAS P BRITTON
Credential	:	DRPH,LCP,LCAS,CCS
Telephone Number	:	312-663-1130

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	06/03/2016

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