Basic Information
| Provider Information | |||||||||
| NPI: | 1700334992 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GATEWAYS HOSPITAL AND MENTAL HEALTH CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GATEWAYS HOMELESS SERVICE PROGRAM | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1891 EFFIE ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900261711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236442000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 320 N MADISON AVE STE B | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900043791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236442026 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2016 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | GALIT | ||||||||
| AuthorizedOfficialFirstName: | MONICA ANDREA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 3236442000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 930000058 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.