Provider Demographics
NPI:1174841704
Name:KW GATEWAY COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:KW GATEWAY COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KURTIST
Authorized Official - Middle Name:
Authorized Official - Last Name:WEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-953-9600
Mailing Address - Street 1:5116 BISSONNET ST
Mailing Address - Street 2:401
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4007
Mailing Address - Country:US
Mailing Address - Phone:713-953-9600
Mailing Address - Fax:713-953-9601
Practice Address - Street 1:5116 BISSONNET ST
Practice Address - Street 2:401
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4007
Practice Address - Country:US
Practice Address - Phone:713-953-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty