Basic Information
| Provider Information | |||||||||
| NPI: | 1821078932 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GATEWAY HEALTHCARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 VIRGINIA AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029054444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017248400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101-103 BACON ST | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028605542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017223560 | ||||||||
| FaxNumber: | 4017223593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | GROVER | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4016676518 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | RI633 | RI | N | Agencies | Day Training, Developmentally Disabled Services | 251S00000X | RI633 | RI | N | Agencies | Community/Behavioral Health | 261QM1300X | RI633 | RI | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QR0405X | RI633 | RI | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 324500000X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 261QM0801X | RI633 | RI | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.