Provider Demographics
NPI:1477554871
Name:GATEWAY REHABILITATION CENTER-SQUIRREL HILL
Entity Type:Organization
Organization Name:GATEWAY REHABILITATION CENTER-SQUIRREL HILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TROUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-766-8700
Mailing Address - Street 1:311 ROUSER RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2719
Mailing Address - Country:US
Mailing Address - Phone:412-604-8900
Mailing Address - Fax:412-299-8755
Practice Address - Street 1:5987 BROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:EAST LIBERTY
Practice Address - State:PA
Practice Address - Zip Code:15206-3060
Practice Address - Country:US
Practice Address - Phone:412-697-0928
Practice Address - Fax:412-697-0934
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY REHABILITATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-09
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA707250261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007607430083Medicaid
PA1007607430047Medicaid
PA1007607430034Medicaid