Provider Demographics
NPI:1073796447
Name:EAST GATE CONNECTIONS
Entity Type:Organization
Organization Name:EAST GATE CONNECTIONS
Other - Org Name:EAST GATE MINISTRIES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DYNEZ
Authorized Official - Middle Name:ORTEGA
Authorized Official - Last Name:BOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC
Authorized Official - Phone:302-632-5338
Mailing Address - Street 1:4297 VERNON RD
Mailing Address - Street 2:APT B
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-4215
Mailing Address - Country:US
Mailing Address - Phone:302-632-5338
Mailing Address - Fax:
Practice Address - Street 1:4297 VERNON RD
Practice Address - Street 2:APT B
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952-4215
Practice Address - Country:US
Practice Address - Phone:302-632-5338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-08
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty