Provider Demographics
NPI:1003287210
Name:GATEWAY SERVICES, INC
Entity Type:Organization
Organization Name:GATEWAY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-875-4548
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-0535
Mailing Address - Country:US
Mailing Address - Phone:815-875-4548
Mailing Address - Fax:815-875-8602
Practice Address - Street 1:406 S GOSSE BLVD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-1916
Practice Address - Country:US
Practice Address - Phone:815-875-4548
Practice Address - Fax:815-875-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL199100050C251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services