Provider Demographics
NPI:1093354680
Name:GATEWAY TO SUCCESS, PC
Entity Type:Organization
Organization Name:GATEWAY TO SUCCESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORGENTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC, DVCS
Authorized Official - Phone:719-564-5070
Mailing Address - Street 1:PO BOX 1748
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81215-1748
Mailing Address - Country:US
Mailing Address - Phone:719-369-2898
Mailing Address - Fax:719-896-2874
Practice Address - Street 1:602 YALE PL
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4611
Practice Address - Country:US
Practice Address - Phone:719-275-2301
Practice Address - Fax:719-896-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000150357Medicaid