1558595983 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 1558595983 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:
COASTAL PSYCHIATRIC GROUP
Provider Other Organization Name Type Code:
3
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:
1558595983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3441 CYPRESS MILL RD,
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
BRUNSWICK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31520-2879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-264-0979
Provider Business Mailing Address Fax Number:
912-264-5965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3045 SCARLETT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31520-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-554-8500
Provider Business Practice Location Address Fax Number:
912-280-1523
Provider Enumeration Date:
05/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BONATI
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
912-554-8457

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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