Provider Demographics
NPI:1558595983
Name:GATEWAY BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:GATEWAY BEHAVIORAL HEALTH SERVICES
Other - Org Name:COASTAL PSYCHIATRIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BONATI
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW, DRPH
Authorized Official - Phone:912-554-8457
Mailing Address - Street 1:3441 CYPRESS MILL RD,
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-2879
Mailing Address - Country:US
Mailing Address - Phone:912-264-0979
Mailing Address - Fax:912-264-5965
Practice Address - Street 1:3045 SCARLETT STREET
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1251
Practice Address - Country:US
Practice Address - Phone:912-554-8500
Practice Address - Fax:912-280-1523
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAY BEHAVIORAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health