Provider Demographics
NPI:1326241688
Name:GREGORY ALAN ELLIS DBA GATEWAYS OF TEXAS
Entity Type:Organization
Organization Name:GREGORY ALAN ELLIS DBA GATEWAYS OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-429-7698
Mailing Address - Street 1:6737 BRENTWOOD STAIR RD STE 124
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-3336
Mailing Address - Country:US
Mailing Address - Phone:817-429-7698
Mailing Address - Fax:817-429-1281
Practice Address - Street 1:6737 BRENTWOOD STAIR RD STE 124
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-3336
Practice Address - Country:US
Practice Address - Phone:817-429-7698
Practice Address - Fax:817-429-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities