Provider Demographics
NPI:1073646097
Name:GATEWAY COMMUNITY SERVICE BOARD
Entity Type:Organization
Organization Name:GATEWAY COMMUNITY SERVICE BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BONATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-437-7300
Mailing Address - Street 1:107 LEESWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-2493
Mailing Address - Country:US
Mailing Address - Phone:912-437-7300
Mailing Address - Fax:
Practice Address - Street 1:1000 COMMISSIONER DR
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:GA
Practice Address - Zip Code:31305-9487
Practice Address - Country:US
Practice Address - Phone:912-437-7300
Practice Address - Fax:912-437-9481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities