Provider Demographics
NPI:1225202252
Name:GATEWAY RESIDENTIAL SERVICES, INC
Entity Type:Organization
Organization Name:GATEWAY RESIDENTIAL SERVICES, INC
Other - Org Name:GATEWAY RESIDENTIAL PROGRAMS, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUKUWUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYENWEAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-722-1433
Mailing Address - Street 1:9334 BEOWULF CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4516
Mailing Address - Country:US
Mailing Address - Phone:443-722-1433
Mailing Address - Fax:443-231-6997
Practice Address - Street 1:9334 BEOWULF CIR
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4516
Practice Address - Country:US
Practice Address - Phone:443-722-1433
Practice Address - Fax:443-231-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDDA-19244-07320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities