Provider Demographics
NPI:1467809244
Name:GATEWAY MOUNTAIN CENTER
Entity Type:Organization
Organization Name:GATEWAY MOUNTAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-205-6245
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95728-0995
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10038 MEADOW WAY UNIT A
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4974
Practice Address - Country:US
Practice Address - Phone:530-426-2110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOCIAL AND ENVIRONMENTAL ENTREPRENEURS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90265251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management