1770616104 NPI number — GATEWAY BEHAVIORAL HEALTH SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770616104 NPI number — GATEWAY BEHAVIORAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GATEWAY BEHAVIORAL HEALTH SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770616104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 COMMISSIONER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DARIEN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31305-9487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-437-7300
Provider Business Mailing Address Fax Number:
912-437-9481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 PALMETTO BAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31410-2642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-437-7300
Provider Business Practice Location Address Fax Number:
912-437-9481
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BONATI
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
912-437-7300

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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