Provider Demographics
NPI:1114111788
Name:GIDEON'S GATE MANAGMENT AND TECHNICAL SERVICES
Entity Type:Organization
Organization Name:GIDEON'S GATE MANAGMENT AND TECHNICAL SERVICES
Other - Org Name:GATEWAY MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PASTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:ELDER
Authorized Official - Phone:317-664-1600
Mailing Address - Street 1:PO BOX 44319
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46244-0319
Mailing Address - Country:US
Mailing Address - Phone:317-536-1225
Mailing Address - Fax:
Practice Address - Street 1:546 E 17TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1702
Practice Address - Country:US
Practice Address - Phone:317-536-1225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YP1600X, 284300000X, 374U00000X
IN20040411A103T00000X
171M00000X
IN1638362343900000X, 347B00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No284300000XHospitalsSpecial HospitalGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No347B00000XTransportation ServicesBusGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty