Provider Demographics
NPI:1477849909
Name:GATEWAY FOUNDATION, INC.
Entity Type:Organization
Organization Name:GATEWAY FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT AND CRED SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-663-1130
Mailing Address - Street 1:55 E. JACKSON BLVD.
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604
Mailing Address - Country:US
Mailing Address - Phone:312-663-1130
Mailing Address - Fax:312-663-0504
Practice Address - Street 1:600 W. LINCOLN STREET
Practice Address - Street 2:EAST
Practice Address - City:CASEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62232
Practice Address - Country:US
Practice Address - Phone:618-345-3970
Practice Address - Fax:618-345-3970
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY FOUNDATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-23
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-0538-0044-A324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility