Provider Demographics
NPI:1497804231
Name:GOLD CHRIS ASSOCIATES, LLC
Entity Type:Organization
Organization Name:GOLD CHRIS ASSOCIATES, LLC
Other - Org Name:GATEWAY DAY TREATMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:I
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:JD - MBA
Authorized Official - Phone:732-922-0591
Mailing Address - Street 1:P.O. BOX 2136
Mailing Address - Street 2:1 CENTRE STREET
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712
Mailing Address - Country:US
Mailing Address - Phone:732-922-0591
Mailing Address - Fax:732-922-0593
Practice Address - Street 1:1 CENTRE ST.
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712
Practice Address - Country:US
Practice Address - Phone:732-922-0591
Practice Address - Fax:732-922-0593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10129-02-05261Q00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0006378Medicaid