1427349208 NPI number — GATEWAY FOUNDATION, INC

Table of content: (NPI 1427349208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427349208 NPI number — GATEWAY FOUNDATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GATEWAY FOUNDATION, INC
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:
1427349208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 E. JACKSON, BLVD., SUITE 1500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60604-4102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-663-1130
Provider Business Mailing Address Fax Number:
312-663-0504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 LAKE VICTORIA DRIVE
Provider Second Line Business Practice Location Address:
MAIN FLOOR WEST
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62703-5596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-529-9266
Provider Business Practice Location Address Fax Number:
217-529-9151
Provider Enumeration Date:
04/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BRITTON
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
312-663-1130

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  A-0538-0020-A ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: C/A-0538-0020-A , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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