Provider Demographics
NPI:1508033010
Name:GATEWAY AREA DEVELOPMENT DISTRICT
Entity Type:Organization
Organization Name:GATEWAY AREA DEVELOPMENT DISTRICT
Other - Org Name:GATWAY AREA AGENCY ON AGING
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-780-0090
Mailing Address - Street 1:110 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-7985
Mailing Address - Country:US
Mailing Address - Phone:606-780-0090
Mailing Address - Fax:606-780-0111
Practice Address - Street 1:110 LAKE PARK DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-7985
Practice Address - Country:US
Practice Address - Phone:606-780-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1700080300Medicaid
KY4399609900Medicaid
KY3300143900Medicaid