Basic Information
| Provider Information | |||||||||
| NPI: | 1477963247 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GATEWAY FOUNDATION INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3469 RANCHO RIO WAY | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958341501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162972436 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4049 MILLER WAY | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958171332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164519312 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2014 | ||||||||
| LastUpdateDate: | 05/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHAW | ||||||||
| AuthorizedOfficialFirstName: | AYI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9164519312 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CAS II | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | C340020 | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.