Provider Demographics
NPI:1366851677
Name:THE GATEWAY CENTRE LLC
Entity Type:Organization
Organization Name:THE GATEWAY CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KASHARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KIRKSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-989-4933
Mailing Address - Street 1:PO BOX 440061
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77244-0061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12360 RICHMOND AVE APT 1022
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2404
Practice Address - Country:US
Practice Address - Phone:281-989-4933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage
No252Y00000XAgenciesEarly Intervention Provider Agency