Provider Demographics
NPI:1497077911
Name:GATEWAY HOSPITAL
Entity Type:Organization
Organization Name:GATEWAY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARENT PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:DESANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-503-5764
Mailing Address - Street 1:1891 EFFRIE STREET
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026
Mailing Address - Country:US
Mailing Address - Phone:323-644-2000
Mailing Address - Fax:
Practice Address - Street 1:1891 EFFRIE STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026
Practice Address - Country:US
Practice Address - Phone:323-644-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital