Basic Information
| Provider Information | |||||||||
| NPI: | 1124157342 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GATEWAYS HOSPITAL SOCIAL REHABILITATION PROGRAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1891 EFFIE STREET | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236442030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 423 N HOOVER ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900042306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236442000 | ||||||||
| FaxNumber: | 3239536588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BERRYMON | ||||||||
| AuthorizedOfficialFirstName: | PRINCESS | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMISTRATIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 3236442000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GATEWAYS HOSPITAL AND MENTAL HEALTH CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 930000058 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.