Provider Demographics
NPI:1497884613
Name:GATEWAYS HOSPITAL & MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:GATEWAYS HOSPITAL & MENTAL HEALTH CENTER
Other - Org Name:GATEWAYS COMMUNITY MHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:323-644-2000
Mailing Address - Street 1:1891 EFFIE 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:323-315-1169
Practice Address - Street 1:320 N MADISON AVE STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3791
Practice Address - Country:US
Practice Address - Phone:323-644-2040
Practice Address - Fax:323-660-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
CA191800257323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA168AMedicare Oscar/Certification